Vol 61, No 2 (2023): APRIL 2023 VOLUME 61 NUMBER 2
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Editorial
Abstract 100
Bridging the research-practice gap plays a pivotal role in accelerating the health and well-being targets of the Sustainable Development Goals (SDG)
Yadeta Dessie
At the time, we are halfway through the ambitious global targets of the sustainable development goals (SDG) to be achieved by 2030, which was developed benchmarking the end of the Millennium Development Goals (MDG)(1). From the seventeen goals formulated, good health and well-being (SGD 3) is one where the global nations are investing (2). All those in the driving seat are forging new ways of accelerating these targets in the context of multiple crises and massive economic pressure—a recent memory is the unprecedented COVID-19 crisis that scrambled the world (3). Despite all the stresses, there is a need to look for multiple paths to
catch up with the lags in the first half and speed up during the second half. One way of transpiring this is by efficient evidence generation and translation—evidence generation implies producing evidence, whereas translation means transforming valid evidence into practices(4). The translation exercises are not as easy as producing results where the actors involved must be aware of and set a feasible mechanism where they operate. This editorial note first highlights bridging the research-to-practice divide, elaborating on the current gaps and potential drivers. And then outlines how to bridge the gaps to accelerate SDG progress, presents brief global and
country-level efforts against the challenges, and postulates the future focus areas. In 2008, Butler(5) presented the concept of death in the valley, uttering the significant loss of evidence before it reaches and meets its ultimate objective. This valley—the research-practice gap—is a prevailing challenge, and little effort has been made to mitigate the problem. With the fact that progress has been minimal, putting the topic among the urgent calls for action. The sources and extents of the problem appeared in a series of works titled 'increasing value and reducing waste.’(6, 7). This work was motivated by evidence translation to practice, mainly
attributed to limitations in conceptualization, selection, generation, and reaching the end users—policymakers and practitioners. Though deep and wide in low- and middle-income nations, these problems are global. Several environmental and situational complexities exist in how and to what extent research evidence is translated into policy and practice. These complexities can be explained by factors related to researchers, decision-makers, their engagement, and the context in which they operate. Culture, climate, goals, missions, processes, and time are among a few of these factors. Altogether, these resulted in the impediment of the
research investment contributions to the current health system in rendering timely and quality services (6, 8). For decision-makers and public health actors, proper evidence would improve health outcomes, strengthen health system performance, and act as a steppingstone to achieving health-related SDGs. However, the gains obtained from the research development are minimal due to the above gaps and wastages. So, bridging the research-practice gap plays a central role in achieving the set goals, which should be the main emphasis of the next hepta years in the journey toward SDGs. (2, 4). Creating a convenient landscape for actors—the people, organizations, and networks- drives the translation of evidence. In the ecosystem of these actors, mutual communication, action, and
reflection under collaborative and collective action research and praxis are needed. More importantly, decision-oriented research is one approach that requires due priority due to the dire need for such evidence during this defining moment of the SDG period. This would be more facilitated when researchers and practitioners come closer through emerging frameworks like the exchange and integrative models (9, 10). Along the same line, the recent evolution of translational disciplines with the core concept of co-designing, co-production, and facilitated interventions is a profound means of bridging these gaps to maximize the efficient generation
and uptake of the resulting evidence(9). There have been various attempts in various contexts to bridge these gaps, and they show
promising prospects. Robinson and his colleagues presented how the translational centers have been established and used to bridge the gap in the UK and Australia, indicating that the knowledge/evidence generator and end users/practitioners joint exercise improved the quality and immediate application of evidence generated (11). South Africa and a handful of African countries attempted to design different frameworks, resulting in a promising prospect of producing edible evidence (12, 13). In the Ethiopian case, experiences that can be showcased (are the current joint exercise of the Ministry of Health (MoH), Regional Health Bureaus (RHBs), and researchers through various platforms. These include the Research Advisory Council (RAC) operating at the MoH (14), the Scientific Advisory Panel (SAP) at the Oromia Health Bureau (OHB), and the Knowledge Hub activities at the Amhara Public Health Institute (APHI) supported technically and financially by the Fenot-Harvard/UBC Project. These schemes are meant for joint
evidence synthesis steered towards addressing decision-makers’ needs. Worth mentioning also is the regular evidence-sharing sessions (Agelgil at MoH, Gela at OHB, and Sinki at APHI) to facilitate evidence uptake by bringing researchers’ work to programmers.
In conclusion, making timely and effective decisions in a complex health system takes time and energy. It requires robust and timely evidence co-produced with the end users for an instant translation, which can happen when we bridge the research-practice valley. The ambitious global goals—like the SDG - greatly benefit from bridging the wide gap, which requires packing resolutions/frameworks that facilitates evidence generation, data sharing, and knowledge translations (4, 8). It is about laying the foundation of how the evidence ecosystem must operate, which needs to be properly communicated among all actors. Creating a platform where researchers and practitioners are the subject and object of inquiries is necessary (15). The academia and research institutes—the primary reservoir for researchers and research investments—are expected to creatively steer their research activities in alignment with the global SDG targets. Along the same line, the practitioners/translators must be innovative in expanding the collaboration and tracking evidence generation for instant decisions without delay and wastage. Designing and instituting context-oriented knowledge translation platforms are urgent missions to catch up with the missed opportunities in the previous half of the SDG period.
Original Article
Abstract 152
Time to recovery and predictors among Acute Kidney Injury Patients on Hemodialysis at the National Renal Transplant Center in Ethiopia
Ayantu Tesfaye Lemma , Tigist Workneh Leulseged , Tigist Girma Gemechu, Leja Hamza Juhar
Background: Acute kidney injury (AKI) is defined as a sudden decline in kidney function in 48 hours. Unless diagnosed and managed early, AKI causes significant morbidity and mortality due to the associated increased risk of renal damage with every delay in recovery. There is a paucity of information on the pattern of recovery time from AKI and its contributing factors. Hence, this study aimed to estimate the median time to recovery and identify predictors among AKI patients on dialysis at the national renal transplant center in Ethiopia.
Methods: A retrospective chart review study was conducted among 232 AKI patients on dialysis who were managed at the center from January 2018 to June 2020. Data was summarized and compared using frequency tables, median survival times, KM survival plots and Log-rank tests. To identify predictors of time to recovery from AKI, a Cox Proportional Hazard (PH) survival model was used, where Adjusted Hazard ratio (AHR), 95% CIs for AHR, and P-values were used for interpretation of results. Data management and analysis was done using SPSS software V. 25.0.
Results: From the 232 AKI patients on dialysis, 127 (54.7%, 95% CI=48.7%-61.3%) achieved recovery and the median time to recovery was 25.0 days (95% CI=22.1, 27.9). On the Cox PH model, having cardiovascular disease (AHR=0.51, 95% CI=0.28,0.93, p=0.028), sepsis (AHR=0.59, 95% CI=0.37, 0.95, p=0.031) and acute glomerulonephritis (AGN) (AHR=0.31, 95% CI=0.14,0.71, p=0.005) were found to be significant predictors of time to recovery from AKI.
Conclusions: The median time to recovery from AKI is optimal given the high-risk nature of the studied population. However, this duration may be associated with an increased risk of both short and long-term complications from continued renal damage. Having cardiovascular disease, sepsis and AGN were found to be associated with delayed recovery from AKI. Therefore, strict monitoring of AKI patients in general, and the high-risk groups in particular, is essential for rapid recovery.
Abstract 89
Knowledge of Alcoholic Liver Disease among alcohol consumers & screening of alcohol misuse, dependence, and disorder in Afikpo, Ebonyi, Nigeria: A Community-based Cross-Sectional Study.
Chinelo Aguiyi-Ikeanyi, Chiagoziem Urom-Ndubisi, Owoichoche Agene, Maxwell Adibe
Background: Consumption of alcohol is typical in adults, and modest consumption has reported health benefits. However, daily alcohol consumption above recommended limits is an important cause of Alcoholic Liver Disease (ALD). This study aimed to assess the knowledge of ALD among alcohol consumers and screen for alcohol misuse, dependence, and disorder.
Methods: A community-based cross-sectional survey was carried out from March to December 2020 in Afikpo using a questionnaire to obtain information on alcoholic use disorder and alcohol dependence. Data were analyzed with IBM SPSS to get descriptive statistics, inferential analysis, and P-value used at 5% significance level.
Results: A total of 450 study participants were included in this study, 73.1% were males, while 48.8% had tertiary education. About 62.7% of the respondents were aged between 20 to 60 years while 24.4% were self-employed and 9.1% were farmers. About 361(80.8%) had a good knowledge about ALD. The males had more knowledge of ALD. Adolescents aged 15 to 19 had a mean audit score of 10.774, while adults above the age of 60 had a mean audit score of 12.808. Male respondents had a mean audit score of 11.395, Adolescents had a mean CAGE test score of 1.89 while adults above 60 scored 2.48. Male subjects had a mean score of 2.17 while respondent with primary education had a mean CAGE score of 2.06, however, participants with no education had the highest mean CAGE score of 2.27.
Conclusion: The residents of Afikpo community have a good knowledge of ALD though there is alcohol use disorder, alcohol misuse and dependence in the community.
Gender is the only demographic characteristics that influenced the knowledge of ALD .
Keywords: Alcoholic liver disease (ALD); alcohol dependence; alcohol misuse; alcohol disorder; audit; cage
Abstract 51
Compliance and perception towards COVID-19 preventive protocols among hospital staff in a tertiary health facility, Southwest Nigeria
Kabir Adekunle Durowade, Margaret O. Araoye, Temitayo T. Adedokun, Ebubechukwu B. Ibe, Owoanam...
Background: The COVID-19 outbreak response in Nigeria was challenged by the existing weak health sector and the frontline health workers for COVID-19 pandemic response are exposed to the pathogen. One militating factor undermining the control and prevention of COVID-19 in Nigeria was poor compliance to preventive measures. This study assessed the compliance with COVID-19 prevention protocols among healthcare workers in Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria.
Methods: A cross sectional study and subjects were selected through a multi-stage sampling technique. Data collection was done using interviewer-administered semi-structured questionnaire over a period of five months (June-October, 2021). Data was analyzed using IBM, Statistical Package for Social Sciences (SPSS) version 27.0 and p value was set at <0.05 as the threshold for statistical significance.
Results: Majority (60.1%), of the respondents got information on COVID-19 protocols through seminars and workshops. However, more than a quarter (28.8%) of the respondents said the use of available PPE was suboptimal. More than one-third, (35.8%), of respondents believe the protocols are too strict. There is, however, good perception (93.3%), but relatively lower compliance (58.7%) of COVID-19 protocols among the staff. Age, marital status and sex were associated with compliance towards COVID-19 protocols in this study (P<0.05). Identified significant predictors (p<0.05) of compliance include age (AOR=1.944), female sex (AOR=7.829).
Conclusion: Most respondents had good knowledge of availability, perception of effectiveness, but relatively lower compliance with the COVID-19 protocols in this facility. The government or hospital authority make sure that necessary steps to further boost compliance are taken.
Abstract 43
Magnitude and factors associated with seizure‐related injury among patients with epilepsy at Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia
Yared Mamushet Yifru, Samson Yarega Misiker, Sefonias Getachew, Adamu Addissie
Background: Seizure‐related injuries (SRI) constitute one of the major areas of concern in managing people with epilepsy. Of those, the ones with generalized tonic‐clonic seizures and drop attacks, are prone to sustain motor vehicle accidents, falls, burns, drowning, fractures, soft tissue and head injuries. Hence, this study aimed to assess the magnitude and associated factors of SRI among patients seen at Amanuel Specialized Mental Hospital, Ethiopia.
Methods: A cross‐sectional study was conducted at a regular seizure follow up clinic. A total of 298 patients above 15 years of age were included in this study. Patients’ socio-demographic and clinical data were collected based on interview and record review. Descriptive statistics were done and multivariable logistic regression was used to determine independent predictors of SRI with adjusted odds ratio and corresponding confidence interval. A p-value <0.05 was considered as statistically significant.
Results: A total of 298 patients were included in this study. Of these, 34.9% were reported to have SRI. Lacerations (54.2%), burn (19.8%) and dental-loss (15.8%) were the most common type of injuries. There was a 2.2-fold increase in the odds of SRI among those in grades 1-6 educational levels (AOR=2.19, 95% CI (1.04-4.54)), and a lower risk of SRI was found among those who could read and write (AOR=0.11, 95% CI (0.13-0.86)).
Conclusions: The study documented significant level of SRI among the study population with varied levels of severity. To minimize SRI ,it is essential to target the above predictors through proper surveillance system in the follow-up clinics with continuous advocacy work to the family and working environment.
Abstract 62
Association between angiotensinogen M235T gene polymorphism and risk of hypertension: A case control study among Ethiopian Patients
Addisu Melake, Marye Alemu, Nega Berhane
Background: Hypertension is a major public health problem in both developing and developed nations because it is highly prevalent and is associated with complications. Numerous environmental and genetic variables are linked to the occurrence of the disease. It may be influenced by the renin-angiotensin-aldosterone system, which preserves bodily homeostasis. The angiotensinogen gene M235T polymorphisms that has an effect on the activity of the renin-angiotensin-aldosterone system are related to the high hypertension risk. The aim of this study was to find out the association between angiotensinogen M235T gene polymorphism and the risk of developing hypertension.
Methods: A total of 306 samples - 153 patients with hypertension and 153 age- and sex-matched healthy controls were selected using a simple random sampling technique. Clinical and biochemical variables were measured to assess the associated risk factors. Blood samples from the patients and matched controls were used to isolate deoxyribonucleic acid. The AGT M235T genotypes were identified using polymerase chain reaction and analyzed by agarose gel electrophoresis. Logistic regression with a 95% confidence interval (CI) was employed to assess the risk correlations of AGT gene M235T polymorphisms with hypertension.
Results: Our analysis showed that the AGT-TT genotype (odds ratio [OR] = 3.11, 95% CL = 1.67–5.79, P< 0.001) and T allele (OR = 2.18, 95% CL = 1.56–3.04, P< 0.001) are considerably higher in hypertensive patients than in healthy controls. Our study also identified the clinical risk factors for hypertension, such as, total cholesterol, triglycerol, low density lipoprotein-cholesterol, and high density lipoprotein-cholesterol levels, which were significantly higher in patients compared to controls (P< 0.001).
Conclusion: The AGT M235T genes of the TT genotype and the T allele are associated with an increased risk of hypertension among the Ethiopian patients. A population-based epidemiological study is needed corroborate the association between AGT and HTN.
Systematic review
Abstract 350
The Accuracy of Widal test For Typhoid Fever Diagnosis in Ethiopia: Systematic Review and Meta-Analysis
oumer abdu muhie, Seid Getahun Abdela, Koku Sisay Tamirat
Widal agglutination test is a serologic laboratory investigation that is used in the diagnosis of typhoid fever. It is an easy, relatively cheap, and readily available test with questionable reliability. The test performance differs from setting to setting depending on the technique used and other factors. The accuracy of this test in Ethiopia is poorly understood. So, the aim of this study was to evaluate the diagnostic accuracy of the Widal agglutination test for typhoid fever in Ethiopia.
We conducted a systematic review and meta-analysis. Electronic databases (PubMed/Medline and Google scholar) were searched using preset search engines to identify relevant studies. The methodological quality of the included studies was assessed with a QUADAS2. We extracted important variables from the eligible articles. Statistical analysis was performed by STATA version 14.
The electronic searches yielded 42 articles of which 8 were found eligible for analysis. The quality of these studies was rated to be moderate based on the QUADAS-2. The pooled sensitivity, specificity, and negative and positive predictive values of the Widal test were 80.8%, 53.0%, 98.5%, and 2.1% respectively.
The widal agglutination test has average specificity, very good negative predictive value, and very poor positive predictive value for the diagnosis of typhoid fever. Relying on Widal for the diagnosis of typhoid fever may lead to over-diagnosis of typhoid fever and related complications including inappropriate use of antibiotics. There is an urgent need for rapid and reliable tests for the diagnosis of typhoid fever, particularly in settings like Ethiopia where doing timely culture is not feasible.
The protocol of this systematic review and meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42020194252.
Abstract 42
Comparative efficacy and safety of anti-infective drugs for patients with mild to severe COVID-19: A systematic review and network meta-analysis of randomized controlled trials
Dejene Tolossa Debela, Tsegahun Manyazewal, Abebaw Fekadu, Merga Belina
Background: Different anti-infective drugs have been proposed to treat patients with COVID-19. We carried out a network meta-analysis to assess their relative efficacy and safety.
Methods: We searched relevant databases for all randomized controlled trials that reported the efficacy and/or safety of any anti-infective drugs published up to April 30, 2022. We did both pairwise and network meta-analyses with 95% confidence intervals using a fixed-effect model. We assessed studies for quality of evidence using an extension of the standard Grading of Recommendations, Assessment, Development, and Evaluation approach considering P<0.05 to be statistically significant.
Results: We included 68 RCTs for 27,680 participants on 22 anti-infective drugs. For clinical recovery at 14 days Ivermectin (OR 3.00, 95%CI [1.82; 4.96]; p < 0.0001; moderate certainty evidence), Baricitinib plus Remdesivir (OR 2.20, 95%CI [1.35; 3.53]; p = 0.005; low certainty evidence), and Favipiravir (OR 2.16, 95%CI [1.27; 3.68]; p = 0.004; moderate certainty evidence) were statistically effective than standard of care. There was no statistically significant difference between treatments for the viral clearance at 14 days. In terms of death outcome only combined therapy of Baricitinib and Remdesivir showed statistically significant risks of ratio (RR 0.47, 95%CI [0.23; 0.99]; p = 0.03). Arbidol (RR 0.46, 95%CI [0.23; 0.95]; p = 0.04) was statistically safe drug than standard of care.
Conclusion: This review suggests that Baricitinib plus Remdesivir is more effective than the other drugs in treating patients with COVID-19 in terms of clinical recovery at 14 days, mortality, and adverse event outcomes.
Abstract 64
Monkeypox: Scientometrics of 50 years of global scientific publications
Meisam Dastani, Reza Ahmadi, Jalal Mardaneh
Background: Scientific publications related to epidemic diseases are crucial for controlling and treating such diseases. The present study aimed to explore and analyze international publications on monkeypox through scientometric methods.
Methods: This review is an applied research conducted using the scientometric method with an analytical method. All world scientific publications on monkeypox were extracted from the Web Of Science (WOS) citation database from January 1972 to May 2022 through an appropriate search strategy. Moreover, Excel and the VOS viewer Bibliometrix package of the R programming language were used for data analysis.
Results: In total, 1130 publications related to monkeypox were extracted from the WOS citation database. Most of the publications were original papers published in 2010. The United States, Germany, and the Congo had the most publications on monkeypox. The topic clusters of scientific publications on monkeypox have been in four topic orientations: prevention, epidemiology, treatment, and immune response.
Conclusion: The findings of the present investigation provided a clear picture of the publications and scientific productions of world researchers in the field of monkeypox. Accordingly, researchers and policymakers on monkeypox can better understand the scientific publications on this disease and its dimensions.
Case Series
Abstract 54
COVID-19 related multisystem inflammatory syndrome in children (MIS-C): A case series from Ethiopia
Tinsae Alemayehu, Kaleab Tesfaye, Selamawit Tariku, Demeke Mekonnen, Eden Demessie Firew, Caleb...
Background: One in twenty of people affected by the ongoing COVID-19 pandemic have been children and adolescents. A unique complication in this age group is the Multi-inflammatory syndrome associated with COVID-19 (MIS-C). We report a single-center case series of children diagnosed with MIS-C from Addis Ababa, Ethiopia.
Case descriptions: This case series describes the clinical presentation and treatment outcomes of four male patients presenting at a mean age of 3 years and 11 months. All fulfilled the World Health Organization case definition criteria for the Multi-inflammatory syndrome associated with COVID-19. All were not eligible for vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) at the time of their diagnosis. They were treated with varying combinations of intravenous immunoglobulin, aspirin, and corticosteroids, and all recovered upon completion of their follow-up period.
Conclusion: Cases of Multi-inflammatory syndrome associated with COVID-19 are often misdiagnosed. This case series highlights when to consider such a diagnosis and its therapeutic options.
Review Article
Abstract 39
History and evolution of academic publishing from the perspective of 60 years of the Ethiopian Medical Journal
Yayehyirad Kitaw, Tegbar Yigzaw, Mirkuzie Woldie, Sileshi Lulseged
On the occasion of the 60th Anniversary of the Ethiopian Medical Journal (EMJ), the authors briefly explore the history and current trends in academic publishing globally and in Ethiopia. Notable increases in academic publishing are recorded even though, as part of the global asymmetry in research and academic publishing, the share of Ethiopia and Africa in general remains relatively small. Challenges and opportunities and how the EMJ has handled them are assessed. The several voluntary editors over the years are commended for sustaining the quality, consistency and continuity of the journal under quite difficult circumstances which portends well for the future of the Journal and academic publishing in Ethiopia.
