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2.  Sexual Assault: Pattern and Related Complications among Cases Managed in Jimma University Specialized Hospital 
Background
Sexual assault affects one out of every five women, and it is a substantial public health and human rights problem in developing countries including Ethiopia. There has not been a study which documented the extent of the problem in the study area; hence the objective of this study was to assess the pattern of sexual assault and related complications in cases which were treated at Jimma University Specialized Hospital from November 1, 2011 – October 31, 2012.
Methods
A hospital based cross-sectional descriptive study was conducted with the aim of assessing sexual assault patterns and related complications on 99 sexual assault cases which were managed at the Gynecology Out-patient Department of the Hospital. Data on circumstances of sexual assault, survivor specific demographic characteristics and information on complications and interventions provided were collected by trained third year residents in obstetrics and gynecology using pretested questionnaire after respondent consent was taken. The collected data was cleaned, edited, fed into computer and analyzed using SPSS for windows version 16.0.
Results
The mean (±SD) of the survivors' age was 14 (±5) years; 57.5% of the survivors were children and 68.7% were from rural areas. Three percent of the clients visited the Gynecology Outpatient Department for sexual assault where rape accounted for 78.8%. The majority (76.8%) of the assailants was known to the survivors, 91% were assaulted by one assailant and 5.1% of the rape cases were gang rape. The mean time of presentation after sexual assault to the hospital was 15 days. Survivors had pregnancy test, HIV test and screening for sexually transmitted infections in 76.8%, 99%, 93% respectively of which 17.1%, 5.1%, 14.1% tested positive for pregnancy, HIV, and some STIs respectively. All HIV positive survivors were children under fifteen years of age. Forty percent of the survivors were provided with emergency contraception. In addition, 60.5%, 63%, and 91.9% of them were provided with post-exposure prophylaxis for HIV, STIs prophylaxis and were given counseling respectively.
Conclusion
It has been revealed that sexual assault is a major problem of women and children of less than fifteen years. There were gaps in providing and receiving packages of care and justice system to protect survivors indicating the needs for community intervention and providing quality of care by health care staff.
PMCID: PMC3929922  PMID: 24591793
Sexual assault; assailant; survivors; rape; attempted rape; sexual abuse
3.  Evaluation of Clinical and Pathological Response after Two Cycles of Neoadjuvant Chemotherapy on Sudanese Patients with Locally Advanced Breast Cancer 
Background
The use of neoadjuvant chemotherapy in treating breast cancer has shown efficacy in downstaging primary tumors, and allows breast conservative surgery to be performed instead of mastectomy. This study aims to evaluate patterns of clinical and pathological response after two cycles of neoadjuvant chemotherapy in patients with locally advanced breast cancer.
Materials and Methods
This is a prospective study. Ninety-eight patients who presented from April 2009 through May 2011 with locally advanced breast cancer and treated with neoadjuvant chemotherapy were included.
Results
The clinical response rate was 83%; 11 patients (11.2%) had a complete clinical remission (cCR); 71 had a partial remission (72.4%); 13 had stable disease (13.3%), and 3 had progressive disease (3.1%). Seven patients had complete pathological response.
Conclusion
Neoadjuvant chemotherapy can achieve a high objective response rate in patients with locally advanced breast cancer even after two cycles. We recommend further research to find predictors for response.
PMCID: PMC3929923  PMID: 24591794
Breast cancer; Clinical response; Neoadjuvant chemotherapy
4.  Prevalence of Hypertension and Associated Factors in Bedele Town, Southwest Ethiopia 
Background
Hypertension is the leading cause of death in the world and is the commonest cause for outpatient visits to physicians. The objective of this study was to assess the prevalence of hypertension and its risk factors among adults in Bedele Town, South-west Ethiopia.
Method
A community-based cross-sectional survey was conducted by interviewing participants regarding their socio-demographic characteristics, history of hypertension, its risk factors and knowledge of its complications and treatment. Measurements of their blood pressure, body weight, height, and waist circumferences were also done on the same day. The data were analyzed using SPSS Version 16 statistical software. Chi-square test and odds ratio with 95% CI were used to assess the association between dependent and independent variables. Logistic regression model was used to determine the independent risk factors for hypertension. P-values of < 0.05 were considered statistically significant.
Results
A total of 396 adults of whom 67.4% were males participated in the study. Prevalence of hypertension, defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥ 90 mmHg or reported use of anti-hypertensive medication, was 16.9%. However, only 44.8% of those with hypertension were aware of their status, and the overall control rate of hypertension was only 22.4%. Only age and waist circumference were found to be independent predictors of hypertension in the community.
Conclusion
Hypertension was found to be prevalent in the community. However, the respondents' awareness about the problem and the overall control rates were very low. Activities targeted at increasing awareness of hypertension in the community and its risk reduction are very important for intervention. There should also be a national strategy for early detection and treatment of hypertension and related cardiovascular diseases.
PMCID: PMC3929924  PMID: 24591795
Hypertension; Cardiovascular disease; Ethiopia
5.  Head Injury-A Neglected Public Health Problem: A Four-Month Prospective Study at Jimma University Specialized Hospital, Ethiopia 
Background
Trauma, especially head trauma, is an expanding major public health problem and the leading cause of death of the young and productive part of the world's population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. The intention of this study was to analyze head injury in a setting where most patients in low- and middle-income countries receive treatment, a referral hospital with general but no neurosurgical service like Jimma University Specialized Hospital. The study aims to provide surgeons, hospital managers and health planners working in similar set-ups with baseline information for further investigation and prevention programs intending to reduce the burden of head injury.
Methods
All head injury patients presented to Jimma University Specialized Hospital between March and June 2010 were included in this prospective research. Epidemiological, clinical and management data were collected for the study.
Results
Out of 52 patients, 47 were males. The median age was 20.0 years (SD=13.3). Fights (n=20, 38.5%) and road traffic accidents (n=19, 36.5%) were the most common causes of head injury. Half of the patients sustained mild and 36.5% sustained severe head injury. The initial GCS had a significant correlation with the outcome. The mortality rate was 21.2%. Of all patients 76.9% were managed conservatively.
Conclusion
Prevention of road traffic accidents and improvement of conservative care were identified as major methods to reduce the burden of head injury in a set-up similar to Jimma. Further studies on head injury patients in low-income countries should be done.
PMCID: PMC3929925  PMID: 24591796
Head injury; Traffic accidents; Violence; Low
6.  Free Radical Attack on Membrane Lipid and Antioxidant Vitamins in the Course of Pre-Eclamptic Pregnancy 
Background
Despite the volume of knowledge and daily reports on pre-eclampsia, its pathogenesis is still yet to be ascertained. Oxidative stress (oxidant (free radical) in excess of antioxidant) injury is one of the recently suggested pathogenetic mechanisms. This study, however, was designed to determine second and third trimesters of plasma malondialdehyde (product of free radical attack on membrane lipid) and vitamins C and E in pre-eclamptic Nigerian women.
Subjects and Methods
A Total of 100 subjects, each for pre-eclamptic, apparently normal and non-pregnant women qualified for the study. Venous blood samples were taken in the second and third trimesters of pregnancy and at the point of contact for non-pregnant women. Variables were analyzed using SPSS version 16, taking level of significance to be 0.05.
Results
Plasma malondialdehyde in the third trimester of normal pregnancy (2.03±0.71µmol/l) was found to be significantly higher than the one in the second trimester (1.65±0.62µmol/l) (p<0.0001). For pre-eclamptic subjects, the malondialdehyde in the third trimester (3.13±0.61µmol/l) was also higher than the malondialdehyde in the second trimester (3.00±1.21µmol/l). The mean vitamin C values for subjects with normal pregnancy were similar in the second and third trimesters (38.25±19.66 vs. 38.66±19.40; p=0.882). For subjects with pre-eclampsia, the mean Vit C values were also similar in the 2nd and 3rd trimesters (35.05±18.37 vs. 37.20±24.44µmol/l; p=0.175). Mean vitamin E values in the second and third trimesters were also similar for subjects with normal pregnancy (28.62±13.85 vs. 28.50±13.35µmol/l; p=0.950). A similar finding was observed in pre-eclamptic subjects (25.09±12.79 vs. 28.00±14.83µmol/l; p=0.067).
Conclusion
There was an increased product of membrane lipid attack (malondialdehyde) with no change in plasma levels of vitamins C and E as pregnancy advances into the third trimester of both normal and pre-eclamptic pregnancies. Antioxidant vitamins may not be useful in stopping the progression of free radical attack on membrane lipid to control pre-eclampsia.
PMCID: PMC3929926  PMID: 24591797
Lipid peroxidation; Malondiadehyde; Free radical; Pre-eclampsia; Trimester; Vitamins
7.  Functional Ability, Community Reintegration and Participation Restriction Among Community-Dwelling Female Stroke Survivors in Ibadan 
Background
Stroke is not gender-discriminatory. Yet, the subject of stroke among females has apparently not received significant attention from clinical researchers. The consequences of stroke include functional and psychosocial sequelae which may cause disability, hinder community reintegration and restrict participation. The inter-relationships among functional ability, community reintegration and participation restriction of community-dwelling, female stroke survivors in Ibadan were assessed in this descriptive study.
Methods
Fifty-two community-dwelling female stroke survivors (mean age = 56.55±9.91 years) were surveyed using consecutive sampling technique. Their functional ability level was measured using the Functional Independence Measure (FIM) while London Handicap Scale (LHS) was used to assess their participation restriction. Data were analyzed using Spearman Rank Correlation Coefficient (rho) and Mann-Whitney U test at p = 0.05.
Results
Significantly positive correlations (p< 0.05) were found between functional ability and community reintegration (r = 0.54; p = 0.01) as well as between participation restriction and community reintegration (r = 0.34; p = 0.05). Individuals with left hemiplegia had significantly higher mean rank scores in functional ability (30.41) than those who had right hemiplegia (mean rank scores = 21.94).
Conclusion
Functional ability which appears to be related to stroke laterality showed positive association with both community reintegration and participation restriction. This suggests that improving the functional ability of the stroke survivors may reduce participation restriction and enhance their reintegration into the community. A similar study which compares male and female stroke survivors in the same community is thus necessary.
PMCID: PMC3929927  PMID: 24591798
Stroke; Functional ability; Community Reintegration; Participation Restriction
8.  Assessing Control of Asthma in Jush, Jimma, South West Ethiopia 
Background
Despite international guidelines, asthma control is short of the goal in different parts of the world. The objective of this study was to assess control of asthma in patients older than 14 years at the Chest Clinic of Jimma University Specialized Hospital/JUSH, South West Ethiopia.
Methods
A cross-sectional hospital-based study was conducted on 234 physician-diagnosed asthmatic patients attending the chest follow up clinic from June 01 to July 31, 2012. Asthma control was assessed using the GINA algorithm and the ACT questionnaire. Pulmonary function test was measured using a spirometer for 160 subjects. Data were cleared, entered and analyzed using SPSS version 16 and independent variables were assessed for association with the level of asthma control using bivariate and multinomial analyses.
Results
Using the GINA based algorithm, 42 respondents (26.2%) were considered to have partly controlled asthma and the majority, 117 (76.1%), had uncontrolled asthma. Asthma was uncontrolled (ACT score <19) in 71.4% subjects and well-controlled (ACT score = 20–25) in 28.6%. Inhaled corticosteroids alone or in association with long-acting b-agonists, which are the prophylactic treatments recommended by GINA, were used by only 9 subjects (3.8%). Factors associated independently with asthma control were individual patient's age group, unscheduled visit, frequency of SABA use, type of treatment and perceived rate of asthma control.
Conclusion
Asthma control is unacceptably poor in Jimma, South West Ethiopia. This could be changed through improved appropriate treatment and frequent monitoring to achieve and maintain control.
PMCID: PMC3929928  PMID: 24591799
Control of asthma; Spirometry; Asthma treatment; Sub-Saharan Africa
9.  Risky Sexual Behaviors and Associated Factors Among Male and Female Students in Jimma Zone Preparatory Schools, South West Ethiopia: Comparative Study 
Background
Youth engage in risk sexual behavior due to insufficient knowledge of reproductive health and family planning. Youth sexual behavior is important not only because of the possible reproductive outcomes, but also because of sexually transmitted infections. The level of risks and sexual behaviors are different between male and female youth due to sexual exposure and socio-cultural factors. The aim of this study was to compare risky sexual behaviors and associated factors among male and female preparatory school (grades 11 and 12) students in Jimma Zone.
Methods
A comparative cross-sectional study was conducted in 5 randomly selected preparatory schools of Jimma Zone. A total of 520 students were selected using simple random sampling technique. A structured, pretested and self-administered questionnaire was used to collect data. Both descriptive analysis and binary logistic regressions were performed on the data to understand risky sexual behaviors among students.
Results
Twenty-two (25.9%) of male and 25(21.6%) of female students had two or more sexual partners in the last six months. Eighty-three (32.3%), 113(43.5%) male and female students were sexually at risk in the last six months. Only 8(9.4%) of the male and 10(8.6%) of the female students used condom consistently in the last six months. Female students living away from their parents were 3 times more likely to be at risk than students living with their parents (OR 95%CI 3.0(1.48–6.34)). Female students who consumed alcohol were 7 times more likely to be at risk than those who did not consume alcohol (OR 95%CI 7.27(3.36–15.7)). Male students who consumed alcohol were 2.8 times more likely to be at risk than those who did not consumed alcohol (OR 95%CI, 2.81(1.3–6.06)). Male students who chewed khat were 4.6 times more likely to be at risk than students who did not chew khat (OR 95%CI, 4.58(1.95–10.76).
Conclusion
Living arrangement, educational status of parents, family connectedness, alcohol consumption and khat-chewing were the major predictors of risky sexual behavior. Therefore, School, family and zonal education office should be involved in reducing the risky sexual behavior of school youth.
PMCID: PMC3929929  PMID: 24591800
Risk Sexual Behavior; Gender; School
10.  Patterns of Eye Diseases in Children Visiting a Tertiary Teaching Hospital: South-western Ethiopia 
Background
About 19 million children worldwide live with visual impairments resulting from different ocular morbidities. This study aimed to identify the different causes of eye diseases in children visiting a tertiary eye centre at Jimma University Hospital.
Methods
We conducted a retrospective review of charts of patients of <16 years of age who presented to Jimma University, Department of Ophthalmology (JUDO,) between January 1, 2010 and December 31, 2010. Data on age, sex, final diagnosis and treatments were collected and analyzed using SPSS version 16.0. Ratios, percentages and associations were calculated, interpreted and discussed. P-values below 0.05 were considered statistically significant.
Results
Three-hundred-eighty children were seen at JUDO in the year 2010, most of them repeatedly. We evaluated the reports of 341 children (53% males). Children aged 11–15 years constituted the largest group (37%). The commonest childhood ocular diseases diagnosed in 2010 were ocular surface and eyelid infections (30.5%), ocular allergies (28.1%), ocular traumas and injuries (15.5%) and refractive errors (5.8%). Avoidable eye diseases accounted for about 97% of ocular morbidities.
Conclusion
Infectious causes of childhood ocular diseases are the major reasons of visits of children seen at the Eye Department. Most of the ocular morbidities in children during the study year were either treatable or preventable. Further study on childhood eye diseases at community level is required to design proper preventive and curative strategies for childhood eye diseases in the region.
PMCID: PMC3929930  PMID: 24591801
Childhood eye diseases; visual impairment; Jimma; Ethiopia
11.  Willingness to Pay for Insecticide-Treated Nets in Berehet District, Amhara Region, Northern Ethiopia: Implication of Social Marketing 
Background
Understanding the feasibility of achieving widespread coverage with Insecticide-Treated Nets has to be preceded by learning how people value the Insecticide-Treated Nets and estimating the potential demand and willingness to pay so that sustainability of the intervention can be assured. The objective of this study was to determine willingness to pay for Insecticide-Treated Nets among households in Berehet District, Northern Ethiopia.
Methods
A community-based cross-sectional study was conducted using both quantitative and qualitative methods in five randomly selected Kebeles from January-February 2012. Open ended contingent valuation technique with follow-up method was used. Qualitative data were collected through focus group discussions and observation methods. Binary logistic regression was used to determine the association between dependent and independent variables.
Results
The average number of individuals per Insecticide-Treated Nets was 3.83. Nearly 68.5% persons had willingness to buy Insecticide-Treated Nets if they have access to these Nets. The median maximum price a person is willingness to pay for blue rectangular Insecticide-Treated Net was 20 ETB. People had willingness to pay 30 ETB for blue and white conical insecticide-treated nets. Working on knowledge of malaria (OR=0.68, CI (0.47, 0.98; p<0.05), perceived benefit of Insecticide-Treated Nets (OR=0.28, CI (0.2–0.4; p<0.05), perceived susceptibility (OR=0.64(0.44–0.93; p<0.05) and perceived severity of malaria (OR=0.65(0.47–0.91, p<0.05) had significant association with a willingness to pay Insecticide-Treated Nets. Respondents who prefer kebele/place/ to buy Insecticide-Treated Net for rectangular shape had a significant association with a willingness to pay for Insecticide-Treated Nets (OR=1.92, CI= 1.07–3.92).
Conclusions
Promotions, products, price and place had significant association with willingness to pay for Insecticide-Treated Nets. Designing a social marketing strategy helps ensure sustainable supply of Insecticide-Treated Nets and proper use of Insecticide-Treated Nets.
PMCID: PMC3929931  PMID: 24591802
Willingness to pay; Insecticide-Treated Nets; Social marketing; Malaria
12.  Corneal Pyogenic Granuloma: Rare Complication of Infectious Keratitis 
Background
Pyogenic granuloma is an excessive proliferation of granulation tissue that usually develops after minor trauma or surgery. Ocular involvement usually happens on the external surface and cornea is rarely involved. The objective of our report is to describe the clinicopathological feature of this rare disease and give insight on clinical features that help in the diagnosis.
Case Report
This report presents a case of a four year old child who had fleshy growth of one week duration on the right eye after seven weeks of pain and redness. Slit lamp examination showed vascularized central corneal mass with surrounding stromal infiltrates. The mass was excised, and histopathological examination confirmed pyogenic granuloma of the cornea.
Conclusion
Corneal pyogenic granuloma could be a rare complication of infectious keratitis. Therefore, it should be considered as a differential diagnosis in corneal mass especially after an infection or trauma.
PMCID: PMC3929932  PMID: 24591803
Pyogenic Granuloma; Corneal pyogenic granuloma; Keratitis; Post-infectious granuloma
13.  A Rare Case of Sternal Erosion Due to bronchogenic Carcinoma 
Background
Primary sternal malignancy is very uncommon. Secondary sternal malignancy is usually caused by either hematological dissemination or by direct extension due to parasternal lymph node involvement from breast or lung carcinoma.
Case Details
A 72 years old smoker presented with a dull aching pain over the sternum. Computed tomography (CT) of the thorax revealed osteolytic erosion of manubrium sterni, along with a mass of lesion in the upper lobe of left lung and left sided mediastinal lymphadenopathy. CT guided fine needle aspiration cytology (FNAC) of the left lung mass showed squamous cell carcinoma and FNAC of the sternal lesion revealed metastatic squamous cell carcinoma.
Conclusion
Direct erosion of sternum in case of squamous cell carcinoma of lung is a rarity. We have reported this case to increase the awareness of clinicians regarding the possibility of direct sternal involvement from lung cancer. Moreover, local removal can improve the prognosis.
PMCID: PMC3929933  PMID: 24591804
Sternal erosion; Lung cancer; Local spread
14.  Variant Origin of an Arterial Trunk from Axillary Artery Continuing as Profunda Brachii Artery-A Unique Arterial Variation in the Axilla and its Clinical Implications 
Background
Axillary artery is known to show different variations mostly in its branching pattern. Similarly, the origin of profunda brachii is often encountered with abnormality. Therefore, when the vascular variations in the upper limb persist, mostly it is confined to its branching pattern followed by its variant origin. But, among all the reported variations of profunda brachii, its variant origin from the 3rd part of the axillary artery with common trunk for the branches of axillary artery is unique.
Case Details
We report here an anomalous origin of profunda brachii as continuation of an arterial trunk arising from 3rd part of the axillary artery. This common trunk at its commencement passed between 2 roots of median nerve and gave branches of 3rd part of axillary artery before it continued as profunda brachii artery. The further course and branching pattern of profunda brachii were normal.
Conclusion
Since the axillary artery is next choice of artery for arterial canulation in cardiopulmonary bypass procedures, prior knowledge of existence of such variation in its branching pattern helps in avoiding possible diagnostic or interventional therapeutic errors.
PMCID: PMC3929934  PMID: 24591805
axillary artery; common trunk; profunda brachii; vascular variation
15.  Triceps Tendon Avulsion: A Rare Injury 
Background
Triceps tendon avulsion is one of the rare tendinous injuries. Such injuries can easily be missed, and should be kept as a differential diagnosis in all patients who present with pain and swelling at the back of the elbow after a traumatic event.
Case Details
We present a case of triceps tendon avulsion which was missed in the initial workup by a local practitioner. Careful physical examination and evaluation of the X-rays clinched the diagnosis. The patient was treated surgically by transosseous suture technique using the Krakow method. The end result was a good range of movement and a power equal to the uninjured side. A high index of suspicion, physical examination seeking a palpable gap, and search for a ‘flake’ fracture on lateral radiographs will help make the diagnosis of triceps avulsion. Early recognition of these injuries and prompt intervention are the cornerstones of a successful outcome. A second examination after a few days, when the swelling has reduced, should be the standard in doubtful cases or during any unclear joint injury. We recommend a primary repair through a transosseous suture technique using Krakow method for optimal results.
PMCID: PMC3929935  PMID: 24591806
Triceps avulsion; Krakow; Ethibond
17.  Age at Menarche Among In-School Adolescents in Sawla Town, South Ethiopia 
Background
Although a declining trend in age at menarche has been observed in developed countries over decades commonly attributed to childhood excessive weight gain and sedentary life, little is known about this case in the developing countries.
Methods
A cross-sectional study design and multistage sampling was used to include 660 school adolescents for analysis. Data collection included weight and height measurements. Multinomial logistic regression analyses were done for early and late age of menarche, in reference to average age at menarche, to measure the association of age at menarche with some socio-demographic variables and body habits.
Results
The mean age at menarche was 13.9±1.2 years (95%CI, 13.8–14.0). The menarche ages ranged between 10 and 12 years for 10.5%, 13 and 14 years for 54.5%, and 15+ years for 35%. Low menarche age was independently associated with high calorie consumption, high protein diet, more coffee intake, low physical activity and parents' low educational background. Low body mass index, low parents' income, exercise, and Amhara ethnic background were associated with late menarche age.
Coclusion
The mean menarche age found in this study was higher than the report from developed countries. But, the proportion of adolescents with low menarche age was comparable with reports from developed countries. Inactive adolescents were more likely to see menarche earlier than average age. Healthy eating habits, regular exercise and nutrition education need to be promoted among school children.
PMCID: PMC3847528  PMID: 24307818
adolescent; cross sectional; menarche age; Ethiopia
18.  Effects of Information Dissemination Using Video of Indigenous Language on 11–12 Years Children's Dental Health 
Background
Videos as a medium of health education are useful tools. This study evaluated the effectiveness of a dental health education video in the Yoruba language (spoken in southwestern Nigeria) targeted at children from the lower socioeconomic class.
Methods
An interventional study was conducted among 120 children aged 11 and 12 years, randomly selected from three public primary schools in Ibadan, Nigeria. Participants were assigned into three study groups: group 1 watched the video, group 2 received verbal dental health education in the Yoruba language and group 3 were the control. Following this, each participant received a full mouth prophylaxis, and six weeks later, their oral hygiene was assessed using the Simplified Oral Hygiene Index of Greene and Vermillion.
Results
A mean debris score of (1.11), (1.04) and (1.57) was recorded for the video, verbal and control groups respectively (p<0.001). The mean calculus index score was lowest among the verbal group (0.56), followed by the video group (0.75) and highest among the control (1.16) (p<0.001). However, multivariate analysis, controlling for child's age and fathers education, revealed that oral hygiene of the participants in the video group was significantly better by 28.6% compared to the control group while in the verbal education group there was an improvement of 23.4 % in contrast to the control.
Conclusion
This study demonstrated that a culturally appropriate video in an indigenous language can significantly improve oral hygiene among school children from the lower socioeconomic group in Nigeria.
PMCID: PMC3847529  PMID: 24307819
Dental health education; Video; Effectiveness; Nigeria; Child
19.  Bacterial Profile and Antimicrobial Susceptibility Pattern of Isolates Among Burn Patients at Yekatit 12 Hospital Burn Center, Addis Ababa, Ethiopia 
Background
Infection is a common cause of morbidity and mortality in burn patients. Clinical diagnosis of bacteremia and/or sepsis in burn patients is difficult for a number of reasons. It could be symptomatic and/or asymptomatic as a result of immune deficiency secondary to thermal injury.
Methods
A cross sectional study was conducted at Yekatit 12 Hospital Burn Center. Blood specimen and wound swab were collected from burn patients and were cultured by conventional method. Sensitivity/susceptibility pattern of the isolates was determined by disc diffusion method. Some of the risk factors of bacteremia like prior antibiotic use and total body surface area burn were also determined.
Results
Fifty patients were enrolled in the study of whom 21(42%) were found bacteremic. Five different bacteria were isolated from blood specimen. Coagulase negative Staphylococci, 9(42.8%), S. aureus, 8(38.2%), Bacillus spps, 2(9.52%), K. pneumoniae, 1(4.8%), and P. aeruginosa, 1(4.8%), were frequent isolates. From wound swab, S. aureus, (34.04%), and P. aeruginosa, (31.8%), were predominant. Antimicrobial resistance was observed for Ampicillin, (77.4%), Doxycycline, (74.0), Nalidixic acid, (70.5%), Penicillin G, (68.2%), and tetracycline, (67.5%). Total body surface area of burn ≥ 15% was found as a risk factor for bacteremia.
Conclusion
Bacteremia was detected at a rate of 42% among burn patients. Frequent isolates were S. aureus, (34.04%), and P. aeruginosa, (31.8%). About 82.16% of the isolates showed multiple resistances. In light of our findings, regular antibiotic resistance test has to be done for each patient in order to select an appropriate antimicrobial agent.
PMCID: PMC3847530  PMID: 24307820
Bacteraemia; Burn; Sepsis; Thermal injury
20.  Hepatotoxicity and Associated Risk Factors in HIV-Infected Patients Receiving Antiretroviral Therapy at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia 
Background
In Human Immunodeficiency Virus (HIV) infected patients on antiretroviral treatment (ART), hepatotoxicity is life threatening. Its outcome may lead to liver failure and death. This study was conducted to determine the rate and determinants of elevated alanine amino transferase (ALT) (referred as >40IU/L for both males and females).
Methods
A cross sectional study was conducted on HIV infected individuals who are on ART and suspected of drug resistance at Felege Hiwot Referral Hospital, Bahir Dar from July to December 2012. Venous bloods were collected from each patient and processed parallely to determine ALT, number of HIV RNAs, CD4 and CD8 T cells count, anti hepatitis C virus (HCV) and hepatitis B surface antigen.
Results
Out of 269 HIV infected patients receiving ART, 32% were confirmed of grades 1–4 levels of elevated ALT. The rate of severe hepatotoxicity (grade 3 and 4) was 1.84%. Patients with increased CD8 T cell counts (P=0.011; AOR=1.82; CI: 1.12 –2.54), alcohol over use (P=0.014; AOR = 1.23; CI: 1.36–3.29) and detectable HIV-1 RNA copies (P=0.015; AOR=2.07; CI: 1.15–3.74) independently predicts the elevation of ALT.
Conclusions
In HIV infected patients on ART, extreme elevations of ALT were infrequent but minor elevations were common so that patient-linked variables such as use of alcohol intake must be taken in to account for better clinical management of ART patients. The role of active HCV co-infection on the treatment outcome of ART should be further studied.
PMCID: PMC3847531  PMID: 24307821
ALT; HIV; ART; Bahir Dar; Ethiopia
21.  Medication Non-Adherence Among Adult Psychiatric Out Patients in Jimma University Specialized Hospital, Southwest Ethiopia 
Background
Information on adherence of adult psychiatric patients to biological modes of treatment is scarce in Ethiopia. Knowledge on adherence is essential in terms of future prognosis, quality of life and functionality of such patients. This study was conducted to assess the magnitude and associated factors of non-adherence to medication.
Methods
A hospital based cross-sectional study was conducted in November 2011 at the psychiatry facility of Jimma University Specialized Hospital, which provides service to more than 10 mill people. A sample of 422 adults with psychiatric illness in the follow-up outpatients was selected consecutively. Data was collected using a pre-tested questionnaire by face-to-face interview and from patient medical records. The four-item Morisky scale was used to assess degree of medication adherence. Data was analyzed using SPSS version 16 and descriptive, chi-square test and logistic regression statistical methods were used. P-Value of less than 0.05 was considered as statistically significant in the final model.
Results
Out of the 422 patients, 40.3% were females and 59.7% males. The prevalence rate for non-adherence was 41.2%, non-affective psychoses diagnosis contributing the highest rate (44.5%). From the total non-adherent respondents, 78.2% attributed their non-adherence to forgetting. Irregular follow-up, poor social support and complex drug regimen were independently associated variables with non-adherence.
Conclusions
The result of the study showed that non-adherence among psychiatric patients in Southwest Ethiopia is high and revealed possible associated factors. Adherence needs integrated efforts in creating a mechanism in enhancing regular follow-up, informal social support system and ongoing awareness creation among professionals.
PMCID: PMC3847532  PMID: 24307822
mental illness; non-adherence; Jimma University Specialized Hospital; Ethiopia
22.  Soil Transmitted Helminths and Associated Factors Among Schoolchildren in Government and Private Primary School in Jimma Town, Southwest Ethiopia 
Background
Soil transmitted helminth infections are among the most common human infections. They are distributed throughout the world with high prevalence rates in tropical and sub-tropical countries mainly because of lack of adequate sanitary facilities, inappropriate waste disposal systems, lack of safe water supply, and low socio-economic status.
Methods
A comparative cross sectional study was conducted from December 2011 to June 2012 to determine and assess the prevalence of soil transmitted helminths and their associated factors among government and private primary school children. Stool samples were collected from 369 randomly selected children and examined microscopically for eggs of soil transmitted helminth following McMaster techniques. Soil samples were collected from different parts of the school compound and microscopic examination was performed for eggs of the helminths using sodium nitrate flotation technique.
Results
The overall prevalence rate of soil transmitted helminth infections in private and government schools was 20.9% and 53.5% respectively. T. trichiura was the most common soil transmitted helminth in both schools while hookworm infections were identified in government school students only. Type of school and sex were significantly associated with soil transmitted helminth. Soil contamination rate of the school compounds was 11.25% with predominant parasites of A. lumbricoides.
Conclusion
Higher prevalence of soil transmitted helminth infection was found among government school students. Thus, more focus, on personal hygiene and sanitary facilities, should be given to children going to government schools.
PMCID: PMC3847533  PMID: 24307823
Soil transmitted helminths; school children; government and private schools
23.  Quality of Family Planning Services in Primary Health Centers of Jimma Zone, Southwest Ethiopia 
Background
Good quality of care in family planning (FP) services help individuals and couples to meet their reproductive health needs safely and effectively. Therefore, assessment and improvement of the quality of family planning services could enhance family planning services utilization. This study was thus conducted to assess the quality of family planning services in primary health centers of Jimma Zone, Southwest Ethiopia.
Methods
A cross-sectional facility based study was conducted from March 1st–25th, 2011 among family planning clients of government primary health care centers in southwest Ethiopia. Exit interview of 301 family planning clients identified through systematic random sampling technique was carried out using a pre-tested structured questionnaire. Availability of resources was checked using provider interview and inventory checklist. Moreover, a total of 150 consultation sessions were observed using checklist. Descriptive statistics and linear regression coefficients were generated to meet the objective of the study.
Results
There was a shortage of some medical equipment, trained staffs, and information education and communication materials (IEC) in all of the family planning clinics. The mean waiting time at the service delivery points and consultation duration were 16.4 and 10.5 minutes, respectively. The providers used at least one information education and communication material in 33.3% of the consultation sessions. The overall satisfaction score was 8.64. Clients' perception on adequacy of information during consultation (β=0.24; ( 95%CI=0.02-0.16) ease of getting the clinic site, short waiting time (β=0.17; 95%CI=0.15–029) and educational level (β=0.09; 95%CI =0.09–0.29) were significantly associated with overall satisfaction.
Conclusions
The findings of this study showed that there was lack of critical resources for the provision of quality family planning services in all of the primary health care centers included in the study. This has affected important aspects of service provision including the use of IEC materials during consultations. Hence, it is advisable that health managers of the health facilities and the district health office ensure improved availability of trained personnel, IEC materials and other supplies at the clinics.
PMCID: PMC3847534  PMID: 24307824
Family planning; quality of FP services; client satisfaction; Jimma Zone
24.  Is Plaque Removal Efficacy of Toothbrush Related to Bristle Flaring? A 3-Month Prospective Parallel Experimental Study 
Background
Toothbrushes are over-the-counter products; therefore, no special instruction is given to users when they purchase. There are scarce published studies that have investigated about how often toothbrushes should be replaced. Thus, this study aimed to verify the impact of the Progressive Toothbrush Bristle Flaring on plaque control efficacy of toothbrush.
Materials and Methods
Thirty six subjects were randomly selected and underwent complete oral prophylaxis 10 days prior to the Baseline plaque recording. All subjects were provided with new similar toothbrushes and were divided into two groups. New Brush Group changed toothbrush every month and Old month Group used single toothbrush for the whole period of the study. Both groups were assessed for plaque accumulation every month using Turesky et al, (1970) modification of the Quigley and Hein (1962) plaque index. Toothbrush head was photographed and assessed by measuring the brushing surface area on standardized photographs using National Institutes of Health Image Analysis Program (USA).
Results
Both groups showed similar plaque scores at the 40th day; progressive increase in the plaque scores in group without changing the toothbrush were recorded at the 70th and 100th days. As toothbrush flaring increased, the plaque scores also increased in the Old Brush Group. Highest plaque accumulation was recorded in Mandibular Lingual aspects in Old Brush Group.
Conclusion
Progressive increase was seen in the plaque scores with increase in toothbrush bristle flaring.
PMCID: PMC3847535  PMID: 24307825
Toothbrush; Efficacy of Toothbrush; Bristle Flaring; Plaque Removal
25.  Oral Assessment and Nursing Interventions Among Nigerian Nurses-Knowledge, Practices and Educational Needs 
Background
Assessment of oral condition, oral care, and informing the attending doctor of unusual oral findings for possible consultation or referral to a dentist are the advocated roles of hospital nurses. The objective of the study was thus to assess the roles of Nigerian nurses in the assessment of oral conditions of hospitalized patients.
Methods
This questionnaire-based cross-sectional survey of all nurses caring for hospitalized patients in the University of Benin Teaching Hospital was conducted in the first half of 2010.
Results
Of the 384 studied participants, 94.3% considered oral care as an important aspect of nursing care and 73.4% had oral health component in their nursing school curriculum. A total of 80.7% reported suspicious and abnormal findings in hospitalized patients to the attending doctor. Amongst the respondents, 38.0% reported ability to conduct good oral tissue examination. Only 28.1% demonstrated good knowledge of common oral diseases. Three-quarters (73.4%) thought that it is compulsory for nurses to assess the oral condition of hospitalized patients. The 67.7% and 21.9% of the respondents did the assessment on admission and discharge respectively. The majority (90.1%) desired training on oral care of hospitalized patients.
Conclusion
There is a need to improve the skill and competence of nurses in the assessment of oral condition to make them a substantive partner in the oral care of hospitalized patients.
PMCID: PMC3847536  PMID: 24307826
hospitalized patients; nurses; oral condition; roles

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