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Editorial
Abstract 158
Evidence-Informed Policy Making in the Ethiopian Health System: Opportunities and Challenges : Evidence informed policy making in the Ethiopian health system: Opportunities and challenges
Abdulhalik Workicho
Policy development is a complex and iterative process with multiple stages involving multiple stakeholders and demanding resources. In the health system, problems of various nature, often requiring evidence, trigger the policy development process. Evidence Informed Policy Making (EIPM) is believed to increase the credibility, effectiveness, efficiency, equity, trustworthiness, and acceptability of policies and interventions (1). It also facilitates a more efficient use of scarce resources in health care, reduces research waste, and improves transparency and accountability (2, 3). Hence, the interface between evidence and policy-making in the health system is becoming increasingly important. Ideally, the policy-making process would base on scientific evidence and through participating all stakeholders. But of course, scientific evidence is not the only consideration in policy decisions. Contrary to its depiction, the pathway to EIPM in the health system, in fact, in any other sector, is generally non-linear (4).
In most circumstances, including the health system, EIPM is implemented in a system that operates under a complex and dynamic environment that is challenged by uncertainty. It requires a collaborative effort between various stakeholders with divergent perspectives, capacity, interests, accountability, and power of influence (4, 5). In this process, the researchers and policymakers are the main actors. The former is engaged in leading the production of scientific knowledge while the policy maker owns and leads the process of EIPM to support decision-making. Engagement of policymakers through codesigning/cocreating the policy question and agreeing on the evidence generation process is a key aspect in the interaction between the two actors to translate the evidence into action. Therefore, it is required to use systematic approaches and iterative process so we can optimize the attributes of EIPM (1, 4-7). It is also important and necessary that the approaches we follow and the tools we use are comprehensive enough to account for diverse perspective and contexts. Moreover, they should allow flexibility in working in the complex, dynamic and unpredictable ecosystems of evidence and policy (1, 2, 4, 5). Failure to follow EIPM in the health system will result in implementing programs which are less effective and undesirable outcomes.
In the context of Ethiopia, since the implementation of the Health Sector Transformation Plan (HSTP) (8), the focus on using evidence in the policy making pathway has gained a momentum. With a recent revision of the HSTP in to Health Sector Medium Term Development and Investment Plan (HSDIP)(9), the use of evidence in program designing and implementation is also placed at the epicenter implementing all the nine strategic objectives. Furthermore, the Ministry of Health (MoH) recently has revised its organizational structure aiming to efficiently use resources and implement its programs. The restructuring has led to establishment of few new offices but more importantly organized related programs and departments together so they can optimize their implementation capacity. One of the structures newly established offices is the Policy Strategy and Research Lead Executive Office (PSR LEO) which reports directly to the Minister. This office, with its specific role of bringing together the different actors in the policy making process, including researchers and policymakers, will have a significant role in further enhancing the culture of evidence use while developing health policies and strategies in the country. There are also various knowledge translation platforms (KTPs) including the Research Advisory Council (RAC) which engages researchers and program implementers to answer policy relevant questions and provide technical advises. The RAC operates by using available evidence and routine data to answer policy questions and provide recommendations. This plays an important role especially in bridging the gap between researchers and policymakers which in most cases appear to be the main hurdle in the EIPM process. Different technical advisory standing committees or technical working groups also ensure that specific issues supported by evidence are included when policies are formulated.
However, as complex as the EIPM process is, one can mention a number of challenges. In most cases, the weak link between researchers and policymakers has remained to be the bigger challenge. As equal as its robustness, trustworthiness of an evidence relies on engagement of the end users from the very onset. Even though it requires a deliquiate balance on the extent of involvement, cocreating the evidence generation process greatly improves its utilization. The availability and accessibility of high-quality research and data is also one big challenge pushing policymakers to rely on poor quality evidence to inform their decisions. Another challenge is the complexity of the policymaking process. Policymakers must consider a range of factors when developing and implementing policies, including economic, social, and political considerations. At times, policy-makers may under estimate the potential of scientific contributions, inclining to their own perceptions of policy problems. Or, they may want simple answers from research in order to implement quick fixes to pressing policy challenges while ignoring the complexity of conducting research. Policy-makers needing results over relatively short time periods, and sometimes tending to use research only to legitimize political decisions or even rejecting scientific recommendations can also be additional challenges. It is also worth noting the role of special interests and lobbying in the policymaking process. In some cases, special interest groups may exert influence on policymakers by providing them with research or data that supports their agendas.
Original Article
Abstract 161
Risk Factors and Determinants of Pulmonary Function Impairments in Chronic Respiratory Diseases in Ethiopia: A Hospital-based Cross-Sectional Study
Amsalu Bekele, Tewodros Haile Gebremariam, Aschalew Worku , Eyob Kebede Etissa, Hellen Meme, Asma...
Introduction: Chronic respiratory diseases (CRDs) are diseases of the lung airways and parenchyma. Globally, they are the leading causes of morbidity and mortality. This study aimed to characterize the common CRDs, along with their lung function and possible determinants in symptomatic patients attending Bishoftu General Hospital, Ethiopia.
Methods: A cross-sessional study was conducted at the outpatient of Bishoftu Hospital, Ethiopia from June 2019 to March 2020. Consecutive adult patients aged 18 and above with CRDs (≥8 weeks) were recruited. Questionnaires were used to collect data on demographics, symptoms, diagnoses, and putative risk factors. Lung function was measured by spirometry.
Result: A total of 170 participants were recruited, the majority 102(60.0%) were female. The mean age was 49 years (SD=16). The most common symptoms were wheezing in the last twelve months 156 (91.8%), cough 138 (81.2%), and severe exertional breathlessness 137 (80.6%). Thirty-nine (22.9%) were either active or passive smokers. Half of the patients (50.3%) were exposed daily to vapors, dust, gases, or fumes and 58 (34.3%) were exposed to biomass smoke. In total, 138 (81.2%) had a positive allergen skin prick test. Chronic bronchitis (49.1%) and asthma (36.1%) were the most common clinical diagnoses. Classification of lung function revealed 23 (15%) normal, 29 (19%) obstructive, 36(23.5%) restrictive and 61(39.9%) mixed patterns. Airflow obstruction was independently associated with increasing age (p<0.05), exertional breathlessness (p<0.001), previous history of asthma (p<0.05), BMI (p<0.05), and doctor-diagnosed chronic obstructive pulmonary disease (p<0.001) and asthma (p<0.05).
Conclusion: This study shows a high burden of abnormal lung function in patients attending clinics because of CRDs symptoms. These findings support the critical need for spirometry services to determine lung abnormality in patients with chronic respiratory symptoms.
Abstract 374
Bacteriologic Profile, Antibiotics Resistance Pattern, and Outcomes of Patients Admitted to Lancet General Hospital from June 2022 to June 2023: A Retrospective Cohort Study
Zekewos Demissie, Serkalem Nurlegn , Nahom Zemedkun, Yidnekachew Demssis, Bethel Mekuriya, Eyob...
Abstract
Background Prior studies indicated increased antimicrobial resistance in Ethiopia, with related health, economic, and environmental costs. Knowing an institutions and population microbiologic profile allows for proper antibiotic treatment, which substantially impact patients’ outcomes such as healthcare related costs, morbidity, and mortality. The current study assessed the bacteriologic profile, resistance pattern, and treatment outcome in Lancet General Hospital.
Method A retrospective cohort study on the bacteriologic profile, antibiotics resistance pattern, and outcome of patients was done on 128 eligible patients who were admitted to Lancet General Hospital from June 2022 to June 2023. Data from all hospitalized patients with culture-confirmed infection were analyzed. SPSS version 26.0 was used to analyze the data. Association between independent and dependent variables was analyzed using binary logistic regression model.
Results Gram-negative bacteria were recovered in 77% of the cases. Extended-spectrum beta-lactamase producing Enterobacteriaceae was found in 37.5% (54) isolates and carbapenem resistant bacteria were identified in 27.8% of patients. In-hospital mortality from multidrug resistant bacterial infection was 14.8%. Age ≥ 65 years, presence of septic shock, and presence of carbapenem-resistant bacteria were independently associated with increased in-hospital mortality.
Conclusion High number of resistant microorganisms was isolated, and increased mortality was documented from infections caused by carbapenem-resistant bacteria. Multi-center studies should be done to determine the extent of resistant organisms in health facilities throughout the country.epidemiology, and the findings should be factored into clinical decision making and program design for disease prevention, screening, and treatment. It also calls for further prospective research to learn more about the conditions in the context of additional relevant personal and clinical characteristics
Abstract 116
Factors Associated with Neurocognitive Impairment in Treatment Experienced HIV+ Adults: A Perspective from a Tertiary Care Center in Ethiopia: Factors Associated with HAND in Ethiopia
Biniyam A. Ayele, Kiran T. Thakur, Wondwossen Amogne
Background: Given the improvement in life expectancy of people living with HIV (PLWH) in sub-Saharan Afri- ca, the risk of asymptomatic HIV-associated neurocognitive disorder (HAND) has increased. The study objectives were to investigate the prevalence of HAND and associated factors among treatment experienced adults in Ethiopia.
Methods: A single-center observational cross-sectional study was conducted between December 2019 and June 2020 to investigate HAND. International HIV dementia scale (IHDS) was used to screen for the disorder. Both descriptive and analytical statistics were used to analyze the data.
Results: Total of 324 PLWH (63% females) who were on combination antiretroviral therapy for median of 144 months (IQR: 108-168) were investigated. The mean age was 42.5 years (1SD=12.2). The prevalence of HAND was 75.3% and the difference was significantly more in those above 40 years of age (65.8% vs. 80.7%, p=0.003). Age is the only risk factor identified with multivariable logistic regression analysis. A linear decrement in the total score of cognitive performance was observed as the patient’s age increase; age was responsible for 9.4% variation observed in IHDS score (r= -0.31, R2=0.094, p<0.0001). Although statistically not-significant, the trend for cardio- metabolic and behavioral risk factors (hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol and khat use) was higher in the group diagnosed with HAND.
Conclusion: The occurrence of neurocognitive impairment was more pronounced in individuals aged 40 years and above who were HIV positive, compared to those below 40 years. Age was found to be an independent predictor of HAND. Cardiovascular and behavioral risk factors were observed more among patients with HAND compared to no-HAND.
Abstract 96
Sonohysterography Assessment of the Structural Abnormalities of the Uterus in Women with Infertility in Ethiopia
tesfaye Kebede legesse, Mahlet Yigeremu, Asefa Getachew [email protected], Melaku Biruk ,...
Background: Female factor infertility is associated with a high incidence of the uterine cavity and fallopian tube pathology in developing countries with a high prevalence of STDs, therefore various methods are available for structural evaluation of the female reproductive system, among them is saline infusion sonohysterography (SISHG). The study aimed to assess the role of SISHSG in female infertility evaluation in areas where the gold standard investigating modalities are not readily available.
Methods: A hospital-based cross-sectional study was carried out in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, between January 2019 to August 2019 G.C. SISHSG consists of instillation of saline into the endometrial cavity with simultaneous pelvic ultrasonography (US). Fifty consecutive female patients referred to the Radiology Department for SISHSG are included in the study. Sensitivity, specificity, positive and negative predictive values were calculated for 26 patients who had both SISHSG and conventional HSG.
Result: The majority of the patients were in the age group of 35-40(38%) and 34 (68%) had secondary infertility. The commonest abnormalities detected were uterine myoma 10(20%), Asherman syndrome/cervical stenosis 7(14%), and tubal blockage 6(10%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SISHSG in normal study, Asherman syndrome/cervical stenosis and chronic endometritis was 100%, as compared to the gold standard conventional HSG. For bilateral tubal blockage the SISHSG had 50% sensitivity, 90% specificity, 66.7% PPV and 81.8% NPV, however, for unilateral tubal blockage SISHSG had low sensitivity 33%.
Conclusion: SISHSG is readily available, easy-to-do, safe and radiation-free procedure and has high sensitivity and specificity in detecting uterine cavity abnormality. We advocate its use as a first step of investigation modality in the evaluation of female infertility.
Abstract 102
Magnitude and Factors Associated with Catheter Associated Urinary Tract Infection, and Antimicrobial Susceptibility Profile at Hawassa, Sidama Regional State, Ethiopia: A prospective Cross-Sectional Study
Marshet Kefeni, Lambiyo , Tsige, Mulugeta Mengistu, Musa Mohammed Ali
Abstract
Introduction: The use of urinary catheter benefit patients who are unable to urinate for various medical reasons. Despite its use, a urinary catheter during its application may introduce bacteria to the urinary tract and result in Urinary tract infection (UTI). Even though the burden of catheter-associated UTI is expected to be high in resource-limited countries, there is limited data. The aim of this study was to determine the magnitude of culture- confirmed catheter-associated urinary tract infection (CAUTI), associated factors, and antimicrobial susceptibility profiles of bacteria.
Methods: This prospective cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital (HUCSH), Sidama region, from May-August 2022. One hundred forty-nine catheterized patients at HUCSH were included. Socio-demographic, clinical, and laboratory data were collected using structured questionnaire. Urine specimens were cultured on blood and MacConkey agar. Culture-confirmed catheter-associated urinary tract infection was established if >1 X 105 colonies of bacteria per milliliters of urine was detected. The disc diffusion method was used for antimicrobial susceptibility testing. For data analysis, SPSS version 26 was used. Factors associated with culture-confirmed CAUTI were assessed using binary logistic regression.
Results: The magnitude of culture confirmed CAUTI was 30.2% (n=45; 95% CI=22.8−37.6). The most common bacterial isolates were Escherichia coli (n=12; 26.7%), followed by Klebsiella species (n=10; 22.2%), and Staphylococcus aureus (n=6; 13.3%). Duration of catheterization (AOR=9.6, 95% CI=3.8−24.2) and comorbidities (AOR=4.1, 95% CI=1.7−9.8) were significantly associated with culture-confirmed CAUTI. Most Gram- negative bacteria were resistant to commonly prescribed antimicrobial agents.
Conclusions: The magnitude of culture-confirmed CAUTI at HUCSH was high. E. coli was the leading bacteria and most of them were resistant to various types of antimicrobial agents. Duration of catheterization and comorbidities were significantly associated with culture- confirmed CAUTI.
Abstract 100
Complete Blood Count, C-reactive Protein, and Erythrocyte Sedimentation Rate Changes in People with Brucellosis : CBC, CRP and ESR in Brucellosis Patients
Alireza Mohammadzadeh, Mozhgan Khanderoo, Abbasali Abbasnezhad, Mohammad Ghorbani, Sina...
Background: Brucellosis is a major health and economic problem in many parts of the world, including the Middle East. Blood disorders such as anemia, leukopenia, and thrombocytopenia can be seen in brucellosis. However, laboratory findings of this disease are different. Therefore, this study aimed to investigate the changes in complete blood count (CBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in people with brucellosis in Gonabad community health centers.Methods: During the 4 years from May 2016 to May 2019, a prospective study was performed on 221 patients with brucellosis. According to the national guidelines for brucellosis, titers greater than 1/80 for Wright and more than 1/40 for 2-ME were considered positive cases of brucellosis. Using the checklist, information related to CBC, CRP, and ESR test parameters was collected. Results: The results showed that out of 221 patients studied, 58.4% were male and 41.6% were female. The mean age was 44.9±19.8 years for men and 49.3±17.3 years for females. High ESR was seen in 43.4% and positive CRP in 59.7% of patients. Leukopenia in 8.6%, leukocytosis in 9%, neutropenia in 6.8%, neutrophilia in 9.5%, lymphopenia in 3.6%, lymphocytosis in 10%, anemia in 17.2% and thrombocytopenia in 9.5% of patients were seen.
Conclusion: Brucellosis in endemic areas should be considered in the differential diagnosis of patients presenting with thrombocytopenia. Also in high Wright titers, CRP is a more valuable indicator than ESR.
Case Report
Abstract 113
A Case Report of Silico-Tuberculosis
Kibrom Gebreselasie, Tewodros Haile Gebremariam
The End TB strategy aims to eliminate tuberculosis (TB) by 2035. Silicosis, a serious disease on its own, is also a significant risk factor for TB. It was responsible for 280,000 YLLs (years of life lost) and 376,000YLDs (years lived with disability) in 2019. Here we report a patient with silicosis related to artisan gold mining who developed non-tuberculous mycobacterial infection and discuss on the preventive and diagnostic challenges in a resource-constrained setting.
Abstract 141
Magnesium Toxicity Presented as Quadriparesis in Postpartum Period: : Case report
Zekewos Demissie, Seyfemichael Getachew, Sisay Teklu, Abraham Demile, Bezawit Endeshaw, Amanuel...
Quadriparesis may result from numerous neurologic diseases. Any of the causes could occur in the postpartum period. However, some conditions have increased prevalence during peripartal period, such as cerebral venous thrombosis, eclampsia itself, or its treatment with magnesium sulfate causing neuromuscular dysfunction in case of toxicity. Herein, we report a case of magnesium toxicity in a 34-year-old mother in the early postpartum period. This case signifies the importance of magnesium toxicity in patients with decreased renal clearance.
Case Series
Abstract 157
Pulmonary Tuberculosis Mimicking a Lung Cancer: A Case series
Mahader Nigussie Wossene, Genet Hagos Weldemichael, Selome Tarekegn Berhanu, Meron Yafet Berhane,...
Tuberculosis (TB) is an infectious disease that is caused by Mycobacterium tuberculosis. Despite TB being a preventable and curable disease, it still remains to be one of the leading causes of mortality worldwide and continues to be prevalent. TB can manifest in multiple systems, but its primary target is the lungs. Pulmonary TB can present differently depending on the patient's immune status and comorbidities. One atypical presentation of TB is lung mass, which can mimic lung malignancy and cause diagnostic delays.In this case series, we report on four cases in which TB was initially suspected to be lung malignancy. All four patients had lung masses on diagnostic imaging; microbiological testing was positive in only two of the patients and bronchoscopic abnormalities were seen in two of those. In two of the four cases, caseating granulomas were present on biopsy. All four patients attained clinical and radiologic resolution.In conclusion, despite years of knowledge and the prevalence of TB, atypical presentations can still cause diagnostic delays and unnecessary interventions. This case series provides examples of TB mimicking lung cancer, so considering TB as a differential diagnosis for patients presenting with a lung mass is crucial.
The Ethiopian Medical Journal (EMJ) is the official Journal of the Ethiopian Medical Association (EMA) and is devoted to the advancement and dissemination of knowledge pertaining to the broad field of medicine in Ethiopia and other developing countries. EMJ is open access, double-blind peer-reviewed medical journal publishing scientifically valued and influential research outputs in the area of clinical medicine, conventional modern medicine, biomedical research, Preventive Medicine, traditional medicine, and other related researches in the broad area of Medicine. Prospective contributors to the Journal should take note of the instructions of Manuscript preparation and submission to EMJ as outlined in the Author Guideline READ MORE |