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1.  Time to presentation, pattern and immediate health effects of alleged child sexual abuse at two tertiary hospitals in Addis Ababa, Ethiopia 
BMC Public Health  2014;14:92.
Background
Children are vulnerable to abuse and violence because their level of development makes them unable to protect themselves. Such adversities during early childhood may have a negative impact on the future lives of the victims.
This study was done to determine the delay to hospital presentation, clinical manifestations and immediate health effects of child sexual abuse in two tertiary care hospitals in Ethiopia.
Methods
We reviewed records of all cases of child sexual and physical abuse between January 2011 and December 2012. Bivariate and multivariate logistic regression models were used to test the presence and strength of association between time to reporting to hospital and, age and sex of the victim, place of residence and relation of the victim to the perpetrator. Odds ratio and 95% confidence intervals were generated. Significance was taken as p-value < 0.05.
Results
During the study period, we identified records of 275 children who were seen for alleged physical and sexual abuse; they accounted for 0.6% of the outpatient department (OPD) visits. The majority of the victims were cases of sexual abuse (97.3%) and most of them were female (75.7%). The mean age of the victims was 9.5 years (standard deviation (SD) = 4.2 years). The majority of the abusers were known to the victim (73.0%) and male (98.8%). Neighbors (38.95%), teachers (7.9%) and relatives (13.4%) were the most commonly reported perpetrators. The median length of time taken to present to hospital after the abuse incident was 4 days (range = 2 hours to 3 years). Male victims were 2.4 times more likely to have a delay of greater than one week to present to hospital (Adjusted Odds Ratio (AOR), 2.40; 95% Confidence interval (CI), 1.34-4.31; P-value = 0.002). Sexual abuse was associated with various immediate health effects, for example, hymenal tear, urinary tract infection and, perineal laceration or tear.
Conclusion
Presentation for care was often delayed. Male sex was independently associated with a delayed presentation to care. We recommend that further studies are carried out to identify the reasons for delay to reporting and design mechanisms to address them.
doi:10.1186/1471-2458-14-92
PMCID: PMC3909371  PMID: 24476414
Child abuse; Time to reporting; Immediate health effects; Ethiopia
2.  Transient left ventricular systolic dysfunction following surgical closure of large patent ductus arteriosus among children and adolescents operated at the cardiac centre, Ethiopia 
Background
Patent ductus arteriosus (PDA) is one of the commonest congenital heart diseases that require closure within the first few months after birth. The residential area of patients affects the size of the PDA: living in highlands, like most places in Ethiopia, is a risk for having larger sized PDA. Closure of these congenital heart defects is usually performed at an early age in places where capable centers are available. In Ethiopia, closure of these defects is done on mission basis often at an older age. Recently, limited reports came about the occurrence of postoperative left ventricular systolic dysfunction (POLVD) following closure of PDA though full explanation is still lacking.
Objective
To determine the rate of and time to improvement of POLVD and the factors associated with it in children and adolescents who underwent surgical closure of PDA.
Method
All children and adolescents who underwent surgical closure of PDA at the Cardiac Center, Ethiopia (CCE) had postoperative follow up with echocardiography. Serial left ventricular ejection fraction (LVEF) and fiber shortening (FS) values were recorded for all of them. SPSS 20 was used to analyze the data.
Results
A total of 36 children and adolescents who underwent surgical closure of PDA from January 2009 to December 2012 and who fulfilled the inclusion criteria were studied. Their mean age at intervention was 8.52 years (SD = 5.23 years), 77.80% were females. The mean duct size as determined by either echocardiography or intra-operative by the surgeon was 10.31 mm (SD = 3.20 mm). They were followed for a mean duration of 24.80 months (SD = 12.36 months) following surgical closure of PDA. The mean LVEF and FS decreased from 65.06% and 35.28% preoperatively to 54.83% and 28.40% post-operatively respectively. Fifteen (42.86%) of the patients had a post-operative LVEF of less than 55%. The mean time to normalization of systolic function was 5.11 weeks (SD = 3.30 weeks). Having an associated cardiac lesion was an independent predictor of POLVD.
Conclusions
We conclude that there is a high rate of POLVD following surgical closure of large PDA in highlanders. We recommend a serial and systematic follow up of these children postoperatively. Those with a significant cardiac dysfunction may need cardiac medications like Angiotensin Converting Enzyme Inhibitors (ACEI).
doi:10.1186/1749-8090-8-139
PMCID: PMC3691754  PMID: 23721219
Large PDA closure; Highland; Systolic Dysfunction
3.  Predictors of treatment failure and time to detection and switching in HIV-infected Ethiopian children receiving first line anti-retroviral therapy 
BMC Infectious Diseases  2012;12:197.
Background
The emergence of resistance to first line antiretroviral therapy (ART) regimen leads to the need for more expensive and less tolerable second line drugs. Hence, it is essential to identify and address factors associated with an increased probability of first line ART regimen failure. The objective of this article is to report on the predictors of first line ART regimen failure, the detection rate of ART regime failure, and the delay in switching to second line ART drugs.
Methods
A retrospective cohort study was conducted from 2005 to 2011. All HIV infected children under the age of 15 who took first line ART for at least six months at the four major hospitals of Addis Ababa, Ethiopia were included. Data were collected, entered and analyzed using Epi info/ENA version 3.5.1 and SPSS version 16. The Cox proportional-hazard model was used to assess the predictors of first line ART failure.
Results
Data of 1186 children were analyzed. Five hundred seventy seven (48.8%) were males with a mean age of 6.22 (SD = 3.10) years. Of the 167(14.1%) children who had treatment failure, 70 (5.9%) had only clinical failure, 79 (6.7%) had only immunologic failure, and 18 (1.5%) had both clinical and immunologic failure. Patients who had height for age in the third percentile or less at initiation of ART were found to have higher probability of ART treatment failure [Adjusted Hazard Ratio (AHR), 3.25 95% CI, 1.00-10.58]. Patients who were less than three years old [AHR, 1.85 95% CI, 1.24-2.76], chronic diarrhea after initiation of antiretroviral treatment [AHR, 3.44 95% CI, 1.37-8.62], ART drug substitution [AHR, 1.70 95% CI, 1.05-2.73] and base line CD4 count below 50 cells/mm3 [AHR, 2.30 95% CI, 1.28-4.14] were also found to be at higher risk of treatment failure. Of all the 167 first line ART failure cases, only 24 (14.4%) were switched to second line ART with a mean delay of 24 (SD = 11.67) months. The remaining 143 (85.6%) cases were diagnosed to have treatment failure retrospectively by the authors based on their records. Hence, they were not detected and these patients were not offered second line ARTs.
Conclusions
Having chronic malnutrition, low CD4 at base line, chronic diarrhea after initiation of first line ART, substitution of ART drugs and age less than 3 years old were found to be independent predictors of first line ART failure in children. Most of the first line ART failure cases were not detected early and those that were detected were not switched to second line drugs in a timely fashion. Children with the above risk factors should be closely monitored for a timely switch to second line highly active anti-retroviral therapy.
doi:10.1186/1471-2334-12-197
PMCID: PMC3507905  PMID: 22916836
HIV/AIDS; Immunological; Clinical; Predictors; Treatment failure; Delay; Switching; Ethiopia
4.  High load of multi-drug resistant nosocomial neonatal pathogens carried by cockroaches in a neonatal intensive care unit at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia 
Background
Cockroaches have been described as potential vectors for various pathogens for decades; although studies from neonatal intensive care units are scarce. This study assessed the vector potential of cockroaches (identified as Blatella germanica) in a neonatal intensive care unit setup in Tikur Anbessa Hospital, Addis Ababa, Ethiopia.
Methods
A total of 400 Blatella germanica roaches were aseptically collected for five consecutive months. Standard laboratory procedures were used to process the samples.
Results
From the external and gut homogenates, Klebsiella oxytoca, Klebsiella pneumoniae, Citrobacter spp. Enterobacter cloacae, Citrobacter diversus, Pseudomonas aeruginosa, Providencia rettgeri, Klebsiella ozaenae, Enterobacter aeruginosa, Salmonella C1, Non Group A streptococcus, Staphylococcus aureus, Escherichia coli, Acinetobacter spp. and Shigella flexneri were isolated. Multi-drug resistance was seen in all organisms. Resistance to up to all the 12 antimicrobials tested was observed in different pathogens.
Conclusion
Cockroaches could play a vector role for nosocomial infections in a neonatal intensive care unit and environmental control measures of these vectors is required to reduce the risk of infection. A high level of drug resistance pattern of the isolated pathogens was demonstrated.
doi:10.1186/2047-2994-1-12
PMCID: PMC3436638  PMID: 22958880
Blatella germanica; Multi-drug resistant pathogens; Neonatal intensive care unit; Ethiopia

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