Dr. Anteneh Gadisa Belachew

BACKGROUND: The unmet need for family planning (FP) is a major impediment to achieving the sustainable development goal. The COVID-19 pandemic and other contextual, individual, and hospital-related problems are major barriers that reduce FP service uptake. However, most of the studies are quantitative and give due focus to individual and community-level barriers. Therefore, this study tends to explore barriers to the utilization of FP in Ethiopia including health care and contextual barriers. METHODS: A multiple explorative case study design was employed from October to December 2021 and a total of 41 Keyinformant interviews, 32 in-depth interviews, and 13 focus group discussions were performed by using the purposive sampling technique. The data were analyzed with a thematic content analysis approach using NVivo software. RESULT: This study explored barriers to FP in four major teams; individual, community-related, health system, and contextual barriers. It reviled that the community’s misconception, fear of side effects, lack of women’s decision-making autonomy, existing sociocultural norms, religious conditions, topography, covid 19 pandemic, and conflict were the major barriers to FP service utilization. CONCLUSION: Using the four teams mentioned above, this study identified different poor health professional skills, misconceptions, pandemics, functional, and structurally related barriers. As a result, it is recommended that health education for the community and training for health professionals are important. Collaboration between government and non-government organizations is also mandatory for strengthening mentorship and supervision systems and establishing resilient health care that can avoid future pandemics.

Background COVID-19 as pandemic declared by WHO on March 11, 2020 and first case detected in Ethiopia on March 13/2020. The COVID-19 caused a global crisis, including millions of lives lost, public health systems in shock and economic and social disruption. Strategies depend on how an existing health system is organized. Even though public health emergency operation centers of the Ethiopia switched to emergency response, there is no national evidence about infection prevention and control. Therefore, this project aimed to assess the level of infection prevention and control and management of COVID- 19 in Ethiopia, 2021. Methods The cross-sectional study conducted at four regions and one city (Amhara, Oromia, SNNPR, Sidama Region, and Dire Dawa). Being with zonal health departments and woredas health offices, primary health care units were selected. The data were collected electronically through Kobocollect software from November 08-28/2021. Descriptive analysis like frequency and percentage was conducted by SPSS software version 25 and the results were presented by tables, figures and narration. Results Data were collected from 16 hospitals, 92 health centers, and 344 health posts. All hospitals have designated COVID-19 focal person. There were significant number of woredas and PHCUs who didn't have IPC guidelines and protocols. About 11 woredas had no any type of diagnostic tests for COVID-19. Conclusions The study revealed that there were significant gaps on Infection prevention and control practice, shortage of personal protective equipment, isolation and specimen transportation problem, lack of call centers. We recommend concerned bodies to fill the identified gaps.

Cancer causes the highest economic loss of all of the leading 15 causes of death worldwide. The economic loss includes the loss of income and the expenses associated with health care costs. The Low awareness of the community toward cancer, the inadequacy of professionals and service providers, and the high budget consuming nature of the treatments are creating a great burden on the cancer patients. The objective of this study was to calculate patient side cancer treatment cost and to assess the contributing factors, among the cancer patients who were treated at Hawassa University Comprehensive Specialized Hospital. The health facility based cross-sectional study design was employed using a consecutive sampling technique. Questionnaires was used to collect primary data; while chart was used to collect the secondary data. Indirect costs incurred on these patients due to off job days were checked. Descriptive and inferential statistics were applied to illustrate the data. On average, $209.99 was spent on treatment by each cancer patients. Of these, medication cost is the highest ($20.77, IQR = 0.53-112.56) from the direct medical costs, and transportation cost is the highest ($58.33, IQR = 22.0-131.67) from the indirect medical costs. Inpatients paid $245.16 (IQR = 147.64-439.20); while outpatients paid $147.37 (IQR = 81.42-240.50). The patients lose about 55.99% of their average annual income. Outpatients pay $0, 92 less than in patients (P = 0.00, CI -0.72-0.34), and the cost increases by $0.2 for the patients who came from Oromia. The cost of transportation and medication were the one which were significantly affecting the burden; but the total cost of treatment was lesser when compared to similar studies done in different areas. The cost balances toward the patients who came from the Oromiya region. Treatment service has to be extended to West Arsi Zone to minimize the cost of transportation and awareness about cancer is needed in the first place and due attention has to be given to thyroid cancer. Furthermore, facility side study should be done to see the complete picture of the burden.

Background COVID-19 pandemic has a devastating impact on the economies and health care system of sub-Saharan Africa. Healthcare workers (HWs), the main actors of the health system, are at higher risk because of their occupation. Serology-based estimates of SARS-CoV-2 infection among HWs represent a measure of HWs’ exposure to the virus and could be used as a guide to the prevalence of SARS-CoV-2 in the community and valuable in combating COVID-19. This information is currently lacking in Ethiopia and other African countries. This study aimed to develop an in-house antibody testing assay, assess the prevalence of SARS-CoV-2 antibodies among Ethiopian high-risk frontline HWs. Methods We developed and validated an in-house Enzyme-Linked Immunosorbent Assay (ELISA) for specific detection of anti-SARS-CoV-2 receptor binding domain immunoglobin G (IgG) antibodies. We then used this assay to assess the seroprevalence among HWs in five public hospitals located in different geographic regions of Ethiopia. From consenting HWs, blood samples were collected between December 2020 and February 2021, the period between the two peaks of COVID-19 in Ethiopia. Socio-demographic and clinical data were collected using questionnaire-based interviews. Descriptive statistics and bivariate and multivariate logistic regression were used to determine the overall and post-stratified seroprevalence and the association between seropositivity and potential risk factors. Results Our successfully developed in-house assay sensitivity was 100% in serum samples collected 2- weeks after the first onset of symptoms whereas its specificity in pre-COVID-19 pandemic sera was 97.7%. Using this assay, we analyzed a total of 1997 sera collected from HWs. Of 1997 HWs who provided a blood sample, and demographic and clinical data, 51.7% were females, 74.0% had no symptoms compatible with COVID-19, and 29.0% had a history of contact with suspected or confirmed patients with SARS-CoV-2 infection. The overall seroprevalence was 39.6%. The lowest (24.5%) and the highest (48.0%) seroprevalence rates were found in Hiwot Fana Specialized Hospital in Harar and ALERT Hospital in Addis Ababa, respectively. Of the 821 seropositive HWs, 224(27.3%) of them had a history of symptoms consistent with COVID-19 while 436 (> 53%) of them had no contact with COVID-19 cases as well as no history of COVID-19 like symptoms. A history of close contact with suspected/confirmed COVID-19 cases is associated with seropositivity (Adjusted Odds Ratio (AOR) = 1.4, 95% CI 1.1–1.8; p = 0.015). Conclusion High SARS-CoV-2 seroprevalence levels were observed in the five Ethiopian hospitals. These findings highlight the significant burden of asymptomatic infection in Ethiopia and may reflect the scale of transmission in the general population.

Background Despite a glaring need and proven efficacy, prospective surgical registries are lacking in low- and middle-income countries. The objective of this study was to design and implement a comprehensive prospective perioperative registry in a low-income country. Methods This study was conducted at Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia. Design of the registry occurred from June 2021 to May 2022 and pilot implementation from May 2022 to May 2023. All patients undergoing elective or emergent general surgery were included. Following one year, operability and fidelity of the registry were analyzed by assessing capture rate, incidence of missing data, and accuracy. Results A total of 67 variables were included in the registry including demographics, preoperative, operative, post-operative, and 30-day data. Of 440 eligible patients, 226 (51.4%) were successfully captured. Overall incidence of missing data and accuracy was 5.4% and 90.2% respectively. Post pilot modifications enhanced capture rate to 70.5% and further optimized data collection processes. Conclusion The establishment of a low-cost electronic prospective perioperative registry in a low-income country represents a significant step forward in enhancing surgical care in under-resourced settings. The initial success of this registry highlights the feasibility of such endeavors when strong partnerships and local context are at the center of implementation. Continuous efforts to refine this registry are ongoing, which will ultimately lead to enhanced surgical quality, research output, and expansion to other sites.

Back ground: Infantile hypertrophic pyloric stenosis(IHPS) is a common infantile disorder characterized by enlarged pyloric musculature and gastric outlet obstruction(1). IHPS typically presents with progressive projectile non-bilious vomiting this usually commences between second and eighth week of age. To date there is only one article written 23 years ago about IHPS in Ethiopia (9). The objectives of this study were to determine the incidence of IHPS at the Tikur Anbessa teaching referral hospital (TAH) over a period of 2 years, analyze the clinical presentations, mode of treatment and outcomes of treatment. Methods: In this retrospective analysis, medical records of patients admitted to TAH, Addis Ababa, Ethiopia, with a diagnosis of IHPS in the years 2011 and 2012 were revised; information on age, sex, birth order, clinical presentation, treatment and outcomes of treatment were collected and analyzed. Results: Sixty one infants with a diagnosis of IHPS were admitted to TAH, Addis Ababa, Ethiopia over a period of 2 years (2011-2012). The clinical records of 55 infants were retrieved and analyzed. The prevalence was 12.9/1000 admissions. The male to female ratio was 6.86:1. The mean age at admission was 44.47days. The mean duration of illness was 26.91 days. A palpable mass was found in 14(25.5%) of infants and constipation is reported in 14(25.5%). The treatment was Ramstedt’s pyloromyotomy in all cases. There were 6 (10.9%) intra-operative mucosal perforation. Eight patients developed postoperative complications - 6(10.9%) wound infections, and 2(3.8%) pneumonia. Two patients died. Conclusions: This study has shown that IHPS is a common condition affecting infants with a prevalence of 12.9/1000 admissions. There was prolonged duration of illness, prolonged preoperative hospital stay and high proportion of dehydration and electrolyte disturbance. To avoid delay in diagnosis physicians should have high index of suspicion in infants with non-bilious vomiting.

Background :Intussusception is one of the frequent causes of bowel obstruction in infants and toddlers(1). It involves invagination of a portion of intestine into another(2–4). The peak age of occurrence is between the age of 4 and 8 months. The aim of this study is to review the pattern of clinical presentation and seasonal variation of intussusception in our hospital, and to analyze the mode and outcomes of treatment. Patients and Methods: This is a four-year retrospective study of children aged 13 years and below who were admitted and treated for intussusception between January 2011 and December 2014 at the pediatric surgery unit of Tikur Anbesa Specialized Hospital (TAH) in Ethiopia. Information on the patients’ demographic characteristics, clinical presentation, and month of occurrence as well as the operative findings and outcome were obtained from the pediatric surgery unit record book, patient charts, and the operating theatre registry. Results: One hundred and thirty six cases of intussusception were admitted to TAH, Addis Ababa over a four year period, of which 130 charts were retrieved and analyzed. Males dominated in the series. Age distribution showed that 59.2% of the cases were

Background: With the persisting low vaccination intake, particularly in children of low-and middle-income countries (LMICs), seroepidemiological studies are urgently needed to guide and tailor COVID-19 pandemic response efforts in schools and to put mitigation strategies in place for a future post-pandemic resurgence. However, there is limited data on SARS-CoV-2 infection-induced and vaccine-induced humoral immunity in schoolchildren in LMICs, including Ethiopia. Methods: As the spike receptor binding domain (RBD) is the major target for neutralization antibodies and useful to predict the correlates of protection, we used an in-house anti-RBD IgG ELISA to assess and compare infection-induced antibody response at two-time points and BNT162b2 (BNT) vaccine-induced antibody response at a one-time point in schoolchildren in Hawassa, Ethiopia. In addition, we measured and compared the levels of binding IgA antibodies to spike RBD of SARS-CoV-2 Wild type, Delta, and Omicron variants in a small subset of unvaccinated and BNT-vaccinated schoolchildren. Results: When we compare SARS-CoV-2 infection-induced seroprevalences among unvaccinated school children (7-19 years) at the two blood sampling points with a 5-month interval, we observed an over 10% increase, from 51.8% (219/419) in the first week of December 2021 (post-Delta wave) to 67.4% (60/89) by the end of May 2022 (post-Omicron wave). Additionally, we found a significant correlation (p = 0.001) between anti-RBD IgG seropositivity and a history of having COVID-19-like symptoms. Compared to the levels of SARS-CoV-2 infection-induced anti-RBD IgG antibodies before vaccination, higher levels of BNT vaccine-induced anti-RBD IgG antibodies were observed even in SARS-CoV-2 infection-naïve schoolchildren of all age groups (p = 0.0001). Importantly, one dose of the BNT vaccine was shown to be adequate to elicit a strong antibody response in schoolchildren with pre-existing anti-RBD IgG antibodies comparable to that of SARS-CoV-2 infection-naive schoolchildren receiving two doses of BNT vaccine, suggesting a single dose administration of the BNT vaccine could be considered for schoolchildren who had prior SARS-CoV-2 infection when a shortage of vaccine supply is a limiting factor to administer two doses irrespective of their serostatus. Despite the small sample size of study participants, the BNT vaccine is shown to be immunogenic and safe for schoolchildren. Irrespective of schoolchildren's vaccination status, we observed a similar pattern of significantly higher levels of IgA antibodies to Delta-RBD than to Omicron-RBD (p < 0.001) in a randomly selected subset of schoolchildren, yet comparable to Wuhan-RBD, suggesting these schoolchildren were more likely to have had SARS-CoV-2 infection with Delta variant. Additionally, we noted a broader IgA antibody reactivity to SARS-CoV-2 variants in vaccinated schoolchildren with prior SARS-CoV-2 infection, supporting the superiority of hybrid immunity. Conclusion: Our serological data indicate a significant increase in SARS-CoV-2 seroprevalence in children at a post-Omicron five-month follow-up compared to a post-Delta enrolment. Despite the small sample size of study participants, the BNT vaccine is shown to be immunogenic and safe for schoolchildren. Hybrid immunity would likely provide a broader humoral immunity against Wuhan strain, Delta, and Omicron variants than natural infection or vaccination alone does. However, future longitudinal cohort studies in SARS-CoV-2-naïve and COVID-19-recovered schoolchildren receiving the BNT vaccine are needed for a better understanding of the kinetics, breadth, and durability of BNT vaccine-induced multivariant-cross reactive immunity.

Extrapulmonary tuberculosis (TB) constitutes fewer than 15% of all TB cases. Within this category, perianal TB is particularly rare, accounting for under 1% of gastrointestinal TB cases. This report details the presentation and successful treatment of a 35-year- old man with a chronic perianal fistula yielding persistent purulent discharge, which a biopsy confirmed as secondary to TB. Combined surgical and pharmacological management led to a successful resolution. This case emphasizes the importance of including TB in the differential diagnosis for persistent, complex perianal fistulas, especially in settings where TB prevalence is high.