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To assess labor, delivery and postpartum complications in nulliparous women with FGM/C and evaluate the attitude of mothers towards elimination of FGM.A prospective hospital based study using structured questionnaire was conducted between January to March 2015 at Karamara hospital, Jijiga, Ethiopia. All nulliparous women admitted for labor and delivery were included. Data were collected regarding circumcision status, events of labor, delivery; postpartum and neonatal outcomes as well as attitude of mothers towards elimination of FGM/C.Two hundred sixty four (92.0%) of the women had FGM/C with most (93.0%) undergoing Type III FGM. The mean age of the women was 22 yr. Failure to progress in 1st stage and prolonged 2nd stage of labor occurred in 165 (57.0%) and189 (65.6%) of the cases respectively. Caesarean section was performed in 17.0% and instrumental delivery in 23.0%. 64.5% required episiotomies, 83.3% had an anterior episiotomy, 29 % had perineal tears, 25.7%% experienced post-partum hemorrhage and 24% postpartum infection. Among the newborns, there were 6.4% perinatal deaths; 18.8 % low birth weight and 1.5% birth injuries. Almost all complications were more frequently seen in circumcised compared to non-circumcised women.The prevalence of FGM is high and it substantially increases the risk of many maternal complications. Health professionals should be aware of these complications and support/care of women with FGM should be integrated at all levels of reproductive health care provision. Capacity building of responsible health professional should be initiated in the area with intensification of FGM eradication activities.

Knowledge of the characteristics and outcomes of critically ill patients admitted to Medical Intensive Care Unit (MICU) helps with identification of priorities and the resources required to improve care. The objective of this study was to examine admission patterns and outcomes in MICU at St. Paul’s Hospital Millennium Medical College.A retrospective review of 1256 patients’ case notes who were admitted to the MICU at St. Paul’s Hospital Millennium Medical College from 2007 to 2012 was carried out. The data was analyzed by SPSS version 18.0 to obtain descriptive and inferential measurements. P values0.05 were considered significant for all tests.Among specific diagnoses, diabetic ketoacidosis; 187 (14.9%), was the leading cause of admission, followed by all Strokes; 103 (8.2%), and Unspecified Diseases of Circulatory System; 81 (6.4%). The overall mortality rate was 39 %. Strokes were the leading causes of death, accounting for 12.2% of total deaths. The deceased were older than the survivors by five mean age years, mean age (±SD) 41.9 (± 18.5) and 36.7 (± 17.4) years, respectively.Non- communicable will continue to be increasing proportion of ICU admissions in the study. The mortality in this study is also substantial, and reasons looks like late admissions and limited care in the facility. Improving the ICU infrastructure and staffing with skilled personnel might improve the quality of care.

Traumatic brain injury is the leading cause of death and disability in people younger than 40 years of age worldwide.The study primarily aims at assessing the short-term outcome of patients operated for traumatic intracranial hemorrhage.This is a hospital based cross sectional study on patients with traumatic brain injury at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia, between February 2013 and February 2014. Standardized and structured questionnaire was used to collect sociodemographic data. All patients with traumatic brain injury operated following intracranial hemorrhage were included. Glasgow Coma Scale was used to determine the outcome. Difference in proportions was examined using Chi-square test.The study reviewed 91 patients with traumatic brain injury. Their age ranged from 13 to 60 years with a mean (SD) of 32.3 (±12.1). Eighty-seven (95.6%) of the cases were males and 4(4.4%) females and 34(37.4%) of them cases had mild and 30(33%) had severe traumatic brain injury. Acute Epidural Hematoma was seen in 79(86.8%), Acute Subdural hematoma had the highest proportion, 4/11(36.4%), of deaths and it was also significantly associated with unfavorable Glasgow Outcoma Scale at 3 months (p=0.03). Overall, the proportion patients who died was 18.7% with older patients (50 years) had a significantly higher proportion of death (p=0.01). Most of the patients had favorable Glasgow Outcoma Scale ,unfavorable was seen in 22/30 (73.3%) and 17/30 (56.7%) of patients with severe traumatic brain injury at 3 and 6 months, respectively.In conclusion, male predominance was substantially high. Acute Subdural hematoma and old patients had high death rates and unfavorable outcome. Overall the death rate was not different from global figures.

Cardiovascular disease has been identified as emerging epidemic in developing world and Sub-saharan Africa. The prevalence of risk factors associated with cardiovascular disease is not clearly established in our country. We conducted this study to determine the prevalence of cardiovascular disease associated risk factors in Jimma town.A cross-sectional study was conducted in sampled adults in Jimma town. Multi-stage sampling was used by combining simple random sampling to select kebeles of Jimma town and then systematic random sampling to select the house hold .An individual was selected with a lottery method if there were more than one adult in the house hold who fulfills inclusion criteria. Data were collected using the World Health Organization standardized structured questionnaire on cardiovascular risk assessment for developing countries. The study variables included anthropometric measurements, demographic information and behavioral risk factors. The data variables were computed using SPSS version 20.Majority (70.9%) of the respondents have one or more of the seven cardiovascular disease risk factors assessed. Nearly one forth (23.8%) of the study participants were hypertensive, 6.2% were known diabetes and the prevalence of smoking was 11.8% among males 2% among females. The prevalence of overweight/obesity was 26.8 %.Majority were found to have at least one of the risk factors for cardiovascular disease. Hypertension and diabetes mellitus were the most common. Screening programs, health education and awareness creation are recommended to prevent the development of the disease. Large scale prospective study with laboratory data will help to further analyze and strengthen the results for policy makers.

Institutional delivery is very low in Ethiopia, particularly in Oromia where less than one-third of antenatal care attendees utilize the services. This study assessed the magnitude of institutional delivery and associated factors in South West Showa Zone of Oromia.A cross-sectional community based study was conducted in 2010. A stratified cluster sampling technique used to select study districts, villages and households. Four hundred thirty childbearing women with at least one birth in the past 5 years preceding the survey were interviewed. Qualitative study method was employed to supplement the quantitative data. Data analyses were done using SPSS v15. Frequency tables and percentages were used to describe study population. Association of independent variables with outcome variable was measured using odds ratio with 95% confidence interval. Multivariate logistic regression analysis was run to control for confounding variables.Eighty percent (344) respondents were from rural. Mean age of the women was 28.8 (±6.6). Most (70.5%) respondents and 39% of their husbands were uneducated. A quarter of them delivered at health institutions over five years preceding the survey. In a regression model with maternal age, residence, maternal and paternal education, all were significantly associated with use of institutional delivery services. Obstetric factors have also showed a statistically significant association. The qualitative findings revealed that trust in traditional birth attendants and health workers’ negative attitude were among the reasons for not delivering at health institutions.Institutional delivery service utilization in the zone is affected by maternal and paternal education, ANC attendance and duration of labor. Traditional beliefs and health workers’ negative attitude were among the identified barriers. Multiple interventions involving community, service providers and health system are recommended.

Myoma is the most common pelvic tumor and an enormous healthcare concern in women. Complications occur in approximately 10-40% of pregnancies with myomatous uterus. This study is conducted to determine the prevalence and obstetric outcome of grossly visible and/or palpable myoma among women who gave birth by caesarean section.A cross sectional study conducted in three teaching hospitals in Addis Ababa, Ethiopia. Data was collected using a pre-tested questioner.A total of 404 cases were included in the study. The prevalence of myoma was 15.3% (62/404). Only 9.7% (6/62) of the myoma cases were diagnosed preoperatively with ultrasound. The number of myoma per case ranged from 1-to-14 with mean number of 3 ±2.7. The mean diameter of largest single myoma per case was 5.2cm ± 3.4. The commonest location of myoma was subserous being the location in 58.1% (36/62). There was significant association between presence of myoma and age of the woman (P0.05). The adjusted prevalence of myoma increases as women’s age increases, and gestational age and birth weight decreases. In addition, the prevalence of myoma was about two times higher in low (≤6) first and fifth minute APGAR score groups with adjusted prevalences of 22.2% (Vs 14.1% in ≥7 group) and 31.8% (Vs 14.4% in ≥7 group) respectively.The prevalence of myoma during pregnancy in this study is higher than prior reports from similar setups. But, no statistically significant association was observed between the presence of myoma and maternal out come.

Genetic, gonadal, phenotypic and psychological genderis the basis for gender assignment to an individual. Derangement in genetic makeup, under or over exposure to sex hormones and problems related to sex hormone receptors will lead to abnormal development of the external and internal genitalia. Failure to respond for the endogenous androgen, Androgen Insensitivity Syndrome is one of the common causes of genital ambiguity and intersex. In this case series we have presented three girls from a family of seven children visited Tikur Anbassa Specialized Hospital (TASH) with a complaint of primary amenorrhea and diagnosed to have androgen insensitivity syndrome. Their clinical presentation, relevant laboratory and histopathologic findings, karyotype and genetic analysis results are summarized. Potential causes and treatment options are discussed.

The survival of neonates with surgical conditions has greatly improved in developed countries, but still remains poor in developing countries. Available evidence suggests that this is due to several challenges encountered in neonates requiring surgical care. The aim of this study was to determine causes and outcomes of neonatal surgical admissions.retrospective review of medical records of neonates who were admitted and treated at Tikur Anbessa Hospital between January1, 2010 and December 31, 2014. Data were analyzed using descriptive statistics and association between variables measured using regression analysis on SPSS version 16 statistical software.There were a total of 652 surgical neonatal admissions during the study period of which 396 were males, 252 females and 4 with indeterminate genitalia. The male to female ratio was 1.6:1. Majority of the cases 562 (86.2%) had congenital malformation. Lesions of the gastrointestinal tract 282(43.3%), mainly Anorectal malformations followed by abdominal wall defects. Two-third (66.6%) of the cases were surgically managed. Nearly onequarter of them died. The proportion who died ranged from 0.03% for Hirschsprung’s disease to 73.2% for esophageal atresia. The immediate causes of death among these series of neonates were ascribed to septic shock and respiratory failure.Neonatal surgical admission is common in the Hospital. The overall number of deaths in this series of neonatal surgical cases was high. The type of principal diagnosis and the age of the neonates at admission were significantly associated with outcome. Creating awareness about neonatal surgical conditions may help to improve the current poor result.

Even though atrial fibrillation is a common risk factor of stroke which contributes to poor outcome, data concerning this association is scarce in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital.Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head CT scan and ECG results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form.A total of 94 patients with mean age of 67.4±12.4 years and Female to male ratio of 1.13:1 were analyzed. The prevalence of AF was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes respectively. The in hospital case fatality of stroke associated with and without atrial fibrillation was 22.2% and 8% respectively while the rate of improvement at discharge was 34% and 68% respectively. Atrial fibrillation was associated with a low rate of improvement at discharge (OR= 0.28 CI: 0.1-0.78).Atrial fibrillation is common in stroke patients in our hospital, especially in the elderly population. It is associated with low rate of improvement at discharge. Appropriate screening and treatment of atrial fibrillation is invaluable for the primary and secondary prevention of stroke.

Referral is part of patient care when done appropriately. Common reasons for referral include seeking expert advice, technical examination and/or intervention, care beyond the facility’s capacity. Objectives: Determine the rate, reason for and type of cases referred among patients seen at surgical Emergency Room of SPHMMC during May to July 2015.Cross sectional study was done at St. Paul’s Hospital Millennium Medical College Emergency Room, including all surgical patients seen in three months period. Data was collected from the individual patient’s medical records, records of the ER and the liaison office and Interns morning reporting book. Data was analyzed with SPSS version 20.Total of 2,492 patients were seen. The mean number of patients seen per day was 27.7 with a range from 13 to 51. Trauma made 70% (1746) of all cases seen. Cases that needed admission made 30.1% (755), but only 49.5 % (374) of them were admitted. The overall referral rate was 15.3%. The referral rate in patients who needed admission was 50.5 % (381). Trauma made 77.4% (295) of the referrals, mainly orthopedic, 54.6% (161) and neuro-traumas, 38% (112). Among non trauma cases acute abdominal conditions tops, 75% (56). Lack of inpatient beds was the main reason for referral 65.6% (250). Specialist care need was the reason for referral in 34.5% (131) of cases. Among patients referred only 14.4% (55) left the hospital at the time of referrals. Four percent (13) of the kept patients died in the ER waiting for referrals.The rate of referral from St. Paul’s Hospital Millennium Medical College Emergency Room is high. It is higher in trauma cases, specifically orthopedic and neuro-traumas. Main reason for referrals was lack of bed. The capacity of the hospital and other hospitals in AA in absorbing traumas, specifically orthopedic and neurotraumas need to be evaluated and necessary policy adjustments should be implemented. Further study at each hospital and the whole city gives better picture of referrals among hospitals in Addis Ababa.

Tuberculosis outbreaks emerge occasionally in long-term care facilities and various educational establishments. This study was designed to determine the five year overall prevalence and trend of tuberculosis and associated factors among students at Adama Science and Technology University and Addis Ababa University Sidist Kilo campus.A five-year retrospective study was conducted on students’ medical records of tuberculosis Directly Observed Treatment Short Course clinics from September 2009– July 2014. The overall prevalence and the trend of smear positive, smear negative and extra pulmonary tuberculosis cases was determined. Odds ratio with 95 percent confidence interval was calculated for categorical variables using a multivariate logistic regression model to assess the strength of association.A total of 112 and 263 tuberculos cases were recorded in Addis Ababa University Sidist Kilo campus and Adama Science and Technology University, respectively. The mean proportion of tuberculosis cases of all types among the total number of students enrolled at Adama Science and Technology University and Addis Ababa University Sidist Kilo campus was 1098.1 and 511.7 cases per 100,000 population, respectively. There was a statistically significant difference in prevalence of tuberculosis among students in Adama Science and Technology University compared to that in Addis Ababa University Sidist Kilo campus [adjusted odds ration: 2.881, 95% CI (1.76-4.71)]. The trend of tuberculosis prevalence showed a steady decline from the first to the last year of the study period.The number of tuberculosis cases observed among university students in this study was high. Governmental and nongovernmental agencies involved in tuberculosis control must consider higher education institutions as focal points for prevention and elimination of tuberculosis in Ethiopia.

Neglected tropical diseases (NTDs) are important public health problems in Ethiopia. In 2013, the Federal Ministry of Health (FMOH) has launched a national NTD master plan to eliminate major NTDs of public health importance by 2020. Benchmarking the current status of NTDs in the country is important to monitor and evaluate the progress in the implementation of interventions and their impacts. Therefore, this study aims to assess the trends of mortality and Disability-adjusted Life-Years (DALY) for the priority NTDs over the last 25 years.We used the Global Burden of Disease (GBD) 2015 estimates for this study. The GBD 2015 data source for cause of death and DALY estimation included verbal autopsy (VA), Demographic and Health Surveys (DHS), and other disease specific surveys, Ministry of Health reports submitted to United Nations (UN) agencies and published scientific articles. Cause of Death Ensemble modeling (CODEm) and/or natural history models were used to estimate NTDs mortality rates. DALY were estimated as the sum of Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD).All NTDs caused an estimated of 6,293 deaths (95% uncertainty interval (UI): 3699-10,080) in 1990 and 3,593 deaths (95% UI: 2051 - 6178) in 2015, a 43% reduction over the 25 years. Age-standardized mortality rates due to schistosomiasis, STH and leshmaniasis have declined by 91.3%, 73.5% and 21.6% respectively between 1990 to 2015. The number of DALYs due to all NTDs has declined from 814.4 thousand (95% UI: 548 thousand-1.2million) in 1990 to 579.5 thousand (95%UI: 309.4 thousand-1.3 million) in 2015. Age-standardized DALY rates due to all NTDs declined by 30.7%, from 17.6 per 1000(95%UI: 12.5-26.5) in 1990 to 12.2 per 1000(95%UI: 6.5 - 27.4) in 2015. Age-standardized DALY rate for trachoma declined from 92.7 per 100,000(95% UI: 63.2 - 128.4) in 1990 to 41.2 per 100,000(95%UI: 27.4-59.2) in 2015, a 55.6% reduction between 1990 and 2015. Age-standardized DALY rates for onchocerciasis, schistosomiasis and lymphiaticfilariasis decreased by 66.2%, 29.4% and 12.5% respectively between 1990 and 2015. DALY rate for ascariasis fell by 56.8% over the past 25 years.Ethiopia has made a remarkable progress in reducing the DALY rates for most of the NTDs over the last 25 years. The rapid scale of interventions and broader system strengthening may have a lasting impact on achieving the 2020 goal of elimination of most of NTDs. Ethiopia should strengthen the coverage of integrated interventions of NTD through proper coordination with other health programs and sectors and community participation to eliminate NTDs by 2020.

Onchocerciasis is a severe parasitic infection which causes disabling skin and subcutaneous tissue changes. The disease is endemic in many African countries including Ethiopia. In 2013, Ethiopia launched Onchocerciasis elimination program with the goal of attaining interruption of onchocerciasis transmission nationwide by 2020. The country has successfully scaled up interventions and achieved 100% geographic coverage in all known endemic districts. The main strategy for interrupting the disease is mass drug administration (MDA) delivered two times per year. The treatment coverage for the last five years has been maintained at more than 80%. Despite many years of ivermectin MDA the transmission of onchocerciasis in many districts remained unabated. To achieve the 2020 goal, sustained high geographic and therapeutic coverage is required which is validated by coverage surveys. The programme should aim to improve the knowledge and attitude of the community towards the programme in order to improve drug compliance. The partnership between the relevant stakeholders should be strengthened to facilitate open discussions regarding the programme implementation and any challenges that may arise in the control and elimination of the disease. It is also important to consider intensified vector control.

Schistosomiasis and soil-transmitted helminthes are among seventeen WHO prioritized neglected tropical diseases that infect humans. These parasitic infections can be treated using single-dose and safe drugs. Ethiopia successfully mapped the distribution of these infections nationwide. According to the mapping there are an estimated 37.3 million people living in schistosomiasis endemic areas, and 79 million in schistosomiasis and soil-transmitted helminthes endemic areas. The Federal Ministry of Health successfully scaled up Schistosomiasis and schistosomiasis and soil-transmitted helminthes intervention in endemic areas and treated over 19 million individuals in 2015. The Ministry of Health has made a huge effort to establish neglected tropical diseases, including schistosomiasis and soil-transmitted helminthes program in the health system which helped to map majority of the woredas and initiate nationwide intervention. The National control programme is designed to achieve elimination for those diseases as a major public health problem by 2020 and aim to attain transmission break by 2025. The programme focuses on reaching those school-aged children who are not attending school, integration between neglected tropical diseases programme, and further collaboration with the WASH actors.

Podoconiosis is a geochemical disease occurring in individuals exposed to red clay soil of volcanic origin. This Neglected Tropical Disease (NTD) is highly prevalent in Ethiopia. According to the nationwide mapping in 2013, the disease is endemic in 345 districts, where an estimated 35 million people live. The government of Ethiopia prioritized podoconiosis as one of eight priority NTDs and included it in the national integrated master plan for NTDs. An integrated lymphoedema management guideline has been developed. Service expansion has continued in the last few years and lymphoedema management services have been expanded to over one hundred endemic districts. The last few years have been critical in generating evidence about the distribution, burden and effective interventions for podoconiosis in Ethiopia. Although the extent of the problem within Ethiopia is considerable, the country is well positioned to now scale-up elimination efforts. Given the extraordinary progress of the past ten years and the current commitment of government, private and third sectors, Ethiopia seems to be on course for the elimination of podoconiosis in our lifetime. We need continued strong partner commitment, evidence-building, and scale-up of activities to accomplish this.

Injuries are a neglected health problem in developing countries. Ethiopia has a high incidence of road traffic accidents and trauma constitutes about half of surgical emergencies among patient seen at health facilities. The objective of this study was to determine the pattern of trauma among patient seen at emergency outpatient departments of public hospitals in northern EthiopiaRetrospective data on patient seen at the hospitals during a one-year period (January 1, 2013-December 31, 2013) was collected. The source population was all patients who visited the emergency OPD of two public hospitals in Mekelle, Tig ray.The 16-25 year old age group was the most commonly affected age group, accounting for 38.5% followed by the 26-35 year old group (21.4%) of the cases. Males were more frequently involved than females ((74.3%) vs 25.7%). Eighty-three per cent of the patients were from urban areas. Interpersonal violence (31%), accidental falls (19.2%) and Road Traffic Accidents (RTA) (14.1%) were the most common causes of injury. The Head (33.5%) was the most commonly involved part of the body.This study indicates a high burden of trauma in the study area and the need for interventions to control the problem. Given the morbidity and mortality associated with trauma, trauma registry system will be beneficial in Tigray and perhaps for the whole country.

Snakebite is an important public health challenge. Venomous snake bites cause significant morbidity and mortality if treatment measures, especially antivenom therapy, are delayed. We did a case series of 27 adult patients admitted after snakebite to the medical wards of Gondar University Hospital (GUH) from September 2013 to August 2014. The age range was from 15 to 74 years. The male to female ratio was 8:1. The majority (25) of patients presented after 12 hours of being bitten. Most of the bites occurred on the legs. Hematologic complications, including prolonged bedside whole blood clotting test, bleeding complications and Disseminated Intravascular Coagulation, were the common complications detected. The case fatality rate was 4/27 (14.8%). Availability of affordable snake specific antivenom is recommended. A large population study is needed to address the burden in Ethiopia.

Appendiceal mass is one of the complications of acute appendicitis. The management of patients with appendiceal mass is controversial and different treatment options have been suggested.The objective of this study was to assess the results of conservative management of patients with appendiceal mass followed by interval appendicecomy.The study was a retrospective analysis of 73 medical records of patients with appendiceal mass who were managed conservatively between March 2007 and February 2014.Fifty patients were males and 23 patients were females making the male to female ratio of 2.2:1. The mean age was 29.6 ± 6.3 years (range 12-68 years). The maximum incidence was in the 3rd decade. Forty one (55.8%) of the patients presented one week or more after the onset of their illness. Abdominal pain, right lower quadrant (RLQ) direct and rebound tenderness were observed in all patients. Mass was detected in the RLQ in 84.9% of the patients. Sixty five patients (89%) responded to conservative treatment and these patients were discharged after a mean hospital stay of 6.5 1.5 days (range 3-12 days). Interval appendicectomy was done for 58 patients 8-16 weeks after successful conservative management. The mean hospital stay after interval appendicectomy was 3.5 ± 0.5 days with a range of 2-5 days. One patient (1.7%) had a wound infection. There were no deaths.Initial non-operative management of appendiceal mass was successful in most cases and the complication rate after interval appendicecomy seems lower than with early operative treatment.

Diabetes mellitus is becoming a common chronic disease in both developed and developing nations and is associated with significant cardiovascular disease morbidity and mortality. The presence of hypertension in patients with diabetes mellitus doubles the risk of cardiovascular disease including coronary heart disease, congestive heart failure, ischemic and hemorrhagic stroke, renalfailure and peripheral arterial disease.The aim of this study was to assess the pattern of antihypertensive drug therapy among diabetic hypertensive patients in Zewditu Memorial Hospital Diabetic Clinic in Addis Ababa.This is a hospital based retrospective review of medical records of 382 diabetic-hypertensive patients who visited the Zewditu Memorial Hospital Diabetic Clinic in the period between August 2014 and January 2015.The most frequently prescribed antihypertensive drug classes were angiotensin converting enzyme inhibitor in 321 (84%) followed by calcium channel blocker in 229 (60%) and beta blocker in 145 (38%) patients. Enalapril, nifedipine, atenolol, losartan and hydrochlorthiazide were the only angiotensin converting enzyme inhibitor, calcium channel blocker, beta blocker, angiotensin receptor blocker and diuretic prescribed, respectively. Enalapril was used as a monotherapy in 73 (19%) and nifedipine in 26(7%), patients. The recommended target systolic blood pressure140 mmHg and diastolic blood pressure90 mmHg was achieved in only 57 (15%) patients while the remaining 325 (85%) did not attain the target blood pressure. Renal function was assessed in 351(92%) patients, of whom 23 (6%) had renal impairment with an estimated glomerular filtrate rate60 ml/min.The pattern of antihypertensive drug therapy in our patients was consistent with the current treatment guidelines. However, the majority of diabetic-hypertensive patients did not reach target blood pressure.

Pregnancy is a state of high metabolic demand. Anemia and thrombocytopenia, commonly as a result of the normal dilutional effect of increased plasma volume during pregnancy, are frequently seen in pregnant women but are not severe enough to require intervention unless aggravated by deficiency of micronutrients. Nutritional deficiency related anemia is often seen in developing countries. In this study, we describe seven cases of severe thrombocytopenia, anemia and leukopenia (pancytopenia) from the same geographic locality and similar clinical presentation. The cases were referred to the Tikur Anbessa Specialized Hospital (TASH) for investigation and treatment. Potential causes, methods of prevention and treatment options are discussed along with relevant clinical and laboratory findings of the cases.

Female genital mutilation is one of the harmful traditional practices among women and girls. More than 130 million girls and women live today who have undergone female genital mutilation. In Ethiopia, a high prevalence (74.3% national and 68.5% in Amhara region) has been reported. This study was aimed to identify determinant factors of female genital mutilation practices in East Gojjam Zone, Western Amhara, Ethiopiacommunity based cross sectional study was conducted among 730 women aged 15-49 years and having children5 years old in September, 2014. Data were collected using a pretested interviewer administered questionnaire. Descriptive statistics were used to describe study objectives, and bivariate and multivariate analysis to identify determinant factors to female genital mutilation.718 women and 805 daughters participated in the study. FGM prevalence was 689 (96%) and 403 (49%) among women and daughters5 years of age, respectively. Type1 and type 2 FGMs were common and daughters1 years of age exhibited 91% female genital mutilation. Daughters' age, parent education level, residence, women circumcision history, culture, health education, frequent health extension workers follow up and participation in anti FGM interventions were risk factors to female genital mutilation practice.Female genital mutilation practices continues to be a major problem to women and daughter5 years of age in the study area. A number of factors were associated with FGM practices including daughters’ age, parent education level, residence, health education, culture, mothers circumcision history, frequent health extensions workers follow up and participation in anti FGM interventions were determinants to higher FGM practices.

Cysts commonly occurring in the neck include thyroglossal cyst and dermoid cysts in the midline, cystic thyroid nodules, branchial cysts and cystic Hygroma in the lateral neck. Hydatid cyst disease is commonly seen in the right lobe of the liver, the lung and rarely in other parts of the body. In general, cysts in the neck are not common in the second decade of life. In this article, we present a case of hydatid cyst presenting as left lateral cystic mass in an Ethiopian boy. The diagnostic difficulty, the need for diagnostic suspicion and consideration of hydatid cyst in the differential diagnosis and the management options are discussed.

Renal diseases are major causes of morbidity and mortality in pediatric practice. Pediatric patients with renal disease, especially younger ones may present with nonspecific signs and symptoms unrelated to the urinary tract. Unexplained fever or failure to thrive may be the only manifestation. Most children with renal diseases in our hospital arrive very late either because of inadequate health awareness among the parents or failure of recognizing the symptoms of renal diseases at a lower health care level. This review will highlight the symptoms of renal diseases at presentation and outcomes of treatment in children in a major referral hospital.A cross-sectional retrospective chart review was done over a period of 3 years (June, 2012 to May, 2015) in 381 admitted children (Birth-17 years) at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia.Out of 14521 pediatric ward admissions in the study period, kidney diseases accounted for 473 admissions in 381 children, accounting for 3.3% of all admissions. The three most common renal diseases observed were congenital anomalies of the kidney and urinary tract (CAKUT) seen in 127 children (26.8%), followed by nephrotic syndrome in 80 children 16.9% and acute glomerulonephritis in 58 children (12.2%). Other renal diseases observed were urinary tract infection 8.0%, urolithiasis 6.7%, Wilm’s tumor 6.3%, acute kidney injury 4.2% and chronic kidney disease 4.0%. Other less frequently detected diseases were bladder exstrophy, lupus nephritis, Henock shonlein Purpura nephritis and prune-belly syndrome. Out of 381 children 207 (54.3%) recovered normal renal function, 20(5.2%) remained with proteinuria, 13(3.4%) progressed to chronic kidney disease and 11(2.9%) died. Sixty one nephrotic children (76.3%) achieved remission but 17 children (21.3%) remained with proteinuria; one steroid resistant child died of end stage renal disease. Ten children (2.6%) with different renal diseases were lost to follow-up and 5 (1.3%) discharged against medical advice.This data reflects that many of the renal diseases are preventable or potentially curable. Therefore, improvement of pediatric renal services and training of health workers would help in early detection and treatment of these conditions leading to reduction in their morbidity and mortality.

Reexpansion pulmonary edema following repair of missed diaphragmatic hernia is very rare .Here reported is a case of bilateral reexpansion pulmonary edema occurring after reconstruction of left sided post traumatic diaphragmatic hernia. The patient was re intubated and ventilated later put on supplemental oxygen via a catheter through the endotracheal tube followed by extubation and non re breather face mask to compensate for hypoxemia. He was given intravenous diuretics and inotropic support. Forty-eight hours after the acute event, the patient recovered with minimal residual hypoxemia. Reexpansion pulmonary edema after repair of missed diaphragmatic hernia is a rare complication with a high mortality rate of up to 20%. It should be considered in cases of hypoxemia following any chest reexpansion procedure. The exact pathophysiology leading to this complication is not clear but it is believed to be permeability pulmonary edema as a result of pulmonary micro vascular damage. Risk factors for reexpansion pulmonary edema should be evaluated and considered prior to insertion of chest tubes. Treatment is supportive and emphasis should be given for preventive measures.

Ethiopia is one of the countries that has high burden of all forms of tuberculosis and there is no published report on computerized tomography scan and/or magnetic resonance imaging of intracranial tuberculomas. Objective : to review the clinical, computerized tomography and/or magnetic resonance imaging features of intracranial tuberculoma.retrospective review of patient’s medical records of patients operated for intracranial mass that had computerized tomography and/or magnetic resonance imaging brain scans and had histopathological diagnoses, at Tikur Anbessa Specialized Hospital between January 2009 and June 2013.Of 222 operated cases of intracranial mass subjected to histopathological test 29 (14.6%) were found to have tuberculomas, 28 (14.1%) had caseous necrosis and one was a tuberculous abscess, in 25 cases imaging was available for review and were included in the study . There were 15 males and 10 females with age range being 2 to 65 years and with the Median age being 13 years. Twenty patients had computerized tomography and five patients had magnetic resonance imaging. Seizure 15/25 (60%) and headache 11/25 (44%) were the commonest presentation. Solitary or confluent large lesions were seen in 12/25 (48%) of patients. 14/25 (56%) of the lesions had their size between 2 cm and 5 cm. Majority of the lesions 15/25 (60%) were in the frontal and parietal lobes. The lesions were isodense on CT in 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rim enhancement after intravenous administration of the contrast medium.Tuberculoma, more frequently, presented with non-specific clinical findings and chronic seizure disorder and comonly occurred in young patients and often seen infratentorialy. It is often complicated with hydrocephalus in the pediatric age group. Computerized tomography scan and/or magnetic resonance imaging features are not different from reports from other countries.

Physiological range of clinically important hematological laboratory values and lipid profiles of healthy population in Ethiopia is not well assessed.to determine hematologic and lipid profiles of healthy blood donors in Addis Ababa.Red Cross Society located in Addis Ababa was selected as a study area. 336 donors; age range between 18-58 years participated. Venous blood sample was collected by tube containing Ehtylenediaminetetraaceticacid tri potassium (EDTA) for hematology test and sterile tube for lipid test. After centrifugation serum was extracted for lipid test and transported to St. Pauls's Millennium Medical College (SPHMMC) within 5-8hrs of sample collection. IBM.SPSS version 21 was used for data analysis, statistical significance was set at P0.05 and 95% CL was accepted.Red blood cell count, mean corpuscular volume, platelet count and triglyceride level were significantly higher in the present study than the reference range. RBC indices, white blood cell, Hemoglobin, hematocrit, high density lipoprotein, low density lipoprotein and total cholesterol were higher in the reference range used in clinical practice. Significantly higher red blood count (p = 0.000), Hg (p = 0.000), Hematocrit (p = 0.000) and mean corpuscular hemoglobin concentration (p = 0.009) were observed in the male. Significantly higher platelet count and high density lipoprotein were observed among females (p = 0.001 and p = 0.001 respectively). No significant change in hematological laboratory values and lipid profiles was seen across age groups.It is evident from this study that hematological and lipid variables obtained were statistically significantly different from the reference range currently used in clinical practice.

Chronic empyema is a serious problem and is often difficult to manage. Its incidence has dropped worldwide, but continues to pose health problems in low and middle income countries. This study has been conducted to assess the outcome of open thoracic window in patients with neglected chronic thoracic empyemain Ethiopian patients.A six-year (June 2008 to October 2014) retrospective study was conducted on thirty five patients (ten females and twenty five males, age ranging from 30-70 years). Open window thoracostomy was performed on these patients for chronic empyema with residual lung tissue and with or without bronchopleural fistula who failed to respond to the conventional methods of treatment.The etiology was primary empyema in 16 patients, post-traumatic in 12 patients, and post-thoracotomy in seven patients. Spontaneous closure was achieved in 12 patients; simple closure was done on 18 patients; and closure with muscle flap in five patients. In all patients, the cavity cleared from secretions in two to three weeks and the residual space narrowed in seven to nine months. All patients gained weight following the surgery.Our result has revealed that open thoracic window is still an alternative method for the treatment of chronic empyema when the conventional method of treatment fails.

Visceral leishmaniasis (VL) is a ftial and growing public health problem in Ethiopia. VL is recently reported outside the major endemic foci, the lowlands in the northwest and the Omo and Abaroba-plain, Segen and Woito valleys in the southwest. Here, we report a visceral leishmaniasis case from Benishangul-Gumuz Regional state near the Guba area. The patient had no history of travel to known VL endemic areas. The patient is a temporary farm laborer from West Go'jam Zone, Wanbermna District in Amhara Regional State. While in Benishangul-Gumuz, the patient was diagnosed with prolonged and intermittentfever, epistaxis, splenomegaly, skin pallor, diarrhea, cough and oedema. Laboratory diagnosis results showed that he had marked leucopenia, thrombocytopenia and anemia. The patient was suspected of having VL and checked with rK39 immunochromnatography and direct agglutination tests which were positive for anti leishmanial antibodies. After getting full dose of sodium stibogluconate as per the national visceral leishmaniasis treatment guideline, was clinically cured. As the area in Benshangul-Gumuz where this patient contracted visceral leishmaniasis is under social and ecological transformation with large scale projects attracting huge influx of temporary laborers and settlers, due attention is needed with respect to introduction or emergence of VL transmission.

Intussusception is one of the frequent causes of bowel obstruction in infants and toddlers (1). It involves invagination of a portion of intestine into another(2-4). The peak age of occurrence is between the age of 4 and 8 months. The aim of this study is to review the pattern of clinical presentation and seasonal variation of intussusception in our hospital, and to analyze the mode and outcomes of treatment.This is a four-year retrospective study of children aged 13 years and below who were admitted and treated for intussusception between January 2011 and December 2014 at the pediatric surgery unit of Tikur Anbesa Specialized Hospital (TAH) in Ethiopia. Information on the patients' demographic characteristics, clinical presentation, and month of occurrence as well as the operative findings and outcome were obtained from the pediatric surgery unit record book, patient charts, and the operating theatre registry.One hundred and thirty six cases of intussusception were admitted to TAH, Addis Ababa over a four year period, of which 130 charts were retrieved and analyzed. Males dominated in the series. Age distribution showed that 59.2% of the cases were ≤ one year old, and 77.7 % were ≤ two years old. Abdominal pain, vomiting, bloody mucoid diarrhea and a mass palpated abdominally and/or rectally were the most common modes of presentations, with the classic triad of abdominal pain, vomiting and bloody mucoid diarrhea occurring in nearly two third of cases. The highest peak of presentation was in the month of June with 18 (13.9%) cases. The mean duration of symptoms before presentation to our hospital was 5.2 days with a range of 1-21 days. Intraoperatively, it was found that ileocolic intussusception was the most common type. Simple reduction without bowel resection was possible in 70.8% of cases. There were 44 (33.9 %) complications, wound site infection being the most common occurring in 20 (15.4%) cases and there were 6 deaths.Intussusception was more common in the wet season. There was delayed presentation with a higher rate of operative management and bowel resection. The mortality rate has decreased significantly compared with a previous study from this institution.

The treatment response of HCV infection is dependent on genotype and stage of the disease. However, genotype pattern and treatment outcomes of HCV infection among Ethiopian patients has not been studied so far.To evaluate the common HCV genotypes and treatment outcomes among Ethiopian adult patients.Adult patients aged 18 and above with HCV infection referred from various regions of the country were included in the study after written informed consent. As there was no free or insurance coverage for treatment of HCV infection in the country, those who could afford to pay for treatment with PEG Interferon and Ribavirin were recruited during January 1, 2008 through December 31,2013 at United Vision, Adera. Old Airport, and Mexico referral higher clinics in Addis Ababa. Patients with decompensated cirrhosis and pregnant ladies were excluded from the study. The patients were counseled on treatment options, cost, treatment outcomes, adverse drug effects, and possible complications. Data were collected on demographic features, clinical characteristics, viral genotypes, and treatment outcomes during follow up visits until six months after completion of recommended standard treatment. Data were analyzed using SPSS software.A total of 200 adults with chronic HCV infection were treated with PEG-Interferon and Ribavirin (for 24 or 48 weeks according to the genotypes) during the study period. Of the 200 patients enrolled in the study, 120 (60%) were male, 90% were from Addis Ababa, and the median age was 48 years. Sixty per cent of the patients were infected with genotype 4,17% with genotype 1, 13.5% with genotype 2 and 9.5% with genotype 3. Eighty percent of the patients had end of treatment response; of these, 74.4% had undetectable HCV RNA at 6th month after end of treatment. The end of treatment response was noted to be close to 90% for patients with HCV genotypes 2 and.3 infections.This study indicates that genotype 4 is the prevalent HCV genotype followed by 1, 2, and 3 among Ethiopian patients. Treatment with interferon and ribavirin was well tolerated and provided a very good response.

In East Africa, particularly in Ethiopia, bacterial keratitis is a major cause of blindness.The aims of this study were to identify risk factors of bacterial keratitis and the spectrum of bacterial etiologies, and to assess the in-vitro antimicrobial susceptibility of these bacterial isolates at Jimma University Specialized Hospital, Southwest Ethiopia.A prospective study was employed from January 2012 to June 2012 from which a total of 24 patients with bacterial keratitis were included in the study. Corneal scrapings were collected, transported and microbiologically processed using standard operating procedures.Four different predisposing factors for bacterial keratitis were identified: corneal trauma 9 (37.5%), blepharitis 7 (29.2%), herpetic keratitis, and use of contaminated medications 4. Bilateral corneal infection was found in 5 (20.8%) of the cases. A total of 24 corneal scrapings were collected for microbiological evaluation, of which 20 (83%) had bacterial growth. The isolated bacterial pathogens were Pseudomonas aeruginosa 10 (41.7%), Staphyloccus aureus 5 (20.8%), Serratia marcescens 3 (12.5%), followed by Streptococcus pneumoniae 2 (8.3%). Antimicrobial susceptibility testing revealed that 85% of Gram-negative bacilli were susceptible to gentamicin and ciprofloxacin, while 86% of Gram-positive cocci were susceptible to vancomycin and Ciprofloxacin.Corneal trauma was the most common risk factor for bacterial keratitis followed by blepharitis. Bacteriological analysis of corneal scrapings also revealed that P. aeruginosa was the most common isolate followed by S. aureus; the antibiotic with the highest susceptibility was ciprofloxacin. As drug resistance among bacterial pathogens is an evolving process, routine surveillance and monitoring studies should be conducted to provide an update and most effective empirical treatment for bacterial keratitis.

Dyskeratosis congenita (DKC) is a rare, progressive bone marrow failure syndrome that is characterized by the triad of reticulated skin pigmentation, nail dystrophy and oral leukoplakia. Current evidence indicates that DKC is a disease of defective telomere maintenance, ribosome deficiency and protein synthesis dysfunction. Mortality is often associated with bone marrow failure (BMF), development of malignancy and other multisystem complications of the disease. Here we report two Ethiopian brothers with classical signs and symptoms of DKC. The characteristic clinical features, laboratory findings, and clinical course of the two brothers are discussed along with relevant literature review.

Malignant lymphoma is a common primary hematopoietic malignancy. Cross sectional imaging is used commonly. The wide spread availability and diagnostic potential of ultrasound (US) place it at the forefront in the setting of resource limited countries that do not have access to the full range of imaging modalities and in which patients frequently present in the late stages of diseases.Assess the patterns of abdominal organ involvement and ultrasound findings in patients with abdominal lymphoma.69 consecutive patients who came to the US unit of Tikur Anbessa Specialized Hospital (TASH) with the diagnosis of lymphoma were scanned. All examinations were performed by the authors based on standard scanning techniques. Cine and spot images were stored for analysis and finding recorded on a preprepared and pretested format.Eighty nine percent of the patients were below the age of 60 and 75% were males. Chest x-ray and US were the modalities commonly used, while only 6 of 69 had computed tomography (CT) scans. Non-Hodgkin's lymphoma account for 81% of the cases. Lymph nodes were the most common organ involved and abdominal nodes accounted for 61% of the cases. Homogenous and hypoechoic echo appearances were seen in 52% and their pattern of involvement comprised multiple discrete nodes. Comparable overall patterns of involvement were seen in both pathologically confirmed and unconfirmed lymphoma cases. Liver followed by spleen was the most common abdominal organ involved, and organ enlargement and/or multiple variable sized hypoechoic lesions were the most common US findings.Our study emphasizes the continued role of US for lymphoma patients. The US findings and pattern of organ involvement was found to be comparable with previous studies.

Pulmonary tuberculosis (PTB) is one of the most common infectious diseases worldwide, and contributes significantly to morbidity and mortality in developing countries. Despite availability of effective treatment, a significant number of patients suffer from permanent lung damage, which predisposes patients to numerous pulmonary complications.To assess chronic sequelae of patients treated for PTB in a chest clinic at Tikur Anbessa Hospital.This was a retrospective, cross-sectional analysis of patients registered in a clinical database at the chest clinic of Tikur Anbessa specialized Hospital between January and December 2013. Patients with a history of pulmonary tuberculosis treatment were identified and included in the analysis.Among all patients having follow-up at the chest clinic of TASH during the study period, 134 (18.5%) presented with chronic pulmonary complications of TB. Seventy two patients (54%) were male, and the mean and median ages were 40 and 37 years, respectively. Of the study population, 83 (61.9%) patients had clinically significant parenchymal scarring and fibrosis, 40 (29.9%) had bronchiectasis, 5(3.7%) had Aspergilloma, 4(3%) had granuloma/calcification, one patient (0.7%) had pleural thickening, and one patient (0.7%) underwent pneumonectomy during the study period.Fibrosis and bronchiectasis were the most common pulmonary complications of tuberculosis among patients encountered at the TASH chest clinic during the study period. This demonstrates the impact of pulmonary tuberculosis is beyond management of active disease.

Increased urbanization with change in lifestyle in many developing countries exposed them to the challenge of double disease burden, battling with the existing communicable infectious diseases as well as the emerging epidemic of NCDs.To describe trends of medical intensive care unit admission over thirty years in Ethiopia.MICU registries at Tikur Anbessa Specialized Hospital over a thirty year period were examined for discharge diagnosis. Data included for analysis were selected at ten-year interval of equivalent six- months' period from December to May of 1981/82, 1991/92, 2001/02 and 2011/12. Variables included were age, gender, residence, discharge diagnosis, duration of stay in hospital, discharge status, admission date, and admission source. Obtained data were cleaned, coded, recoded and edited. The analysis was done using SPSS 15.0 statistical soft ware.A total of 500 cases are included for analysis. Among these 284 (57%) were male. The mean age was 40.2 ± 18 years rangingfrom 13 to 87 years. The aggregate cardiovascular disease, other non communicable disease and infectious disease as a cause of admission in the past thirty years were 213 (42.6), 141 (22.8), 105 (20.0) respectively. Unlike the other disease category cardiovascular disease increased steeply over the past thirty years. Overall case fatality rate at MICU was 31.6% ranging from 24.8% of other-NCD to 46.7% of infectious diseases.Cardiovascular disease has steeply increased till it became predominant in the last decade at MICU of TASH.

Fibular hemimelia is a rare congenital absence of the fibula that may occur as an isolated anomaly or as a part of a malformation syndrome. Shortening of the extremity is obvious at birth with leg-length discrepancy. On plain radiograph of the leg and foot, significant deficiency or absence of the fibula can be seen. In this case report, a 6 year old boy with fibular hemimelia is presented. Radiological diagnosis and differential diagnosis are discussed.

Injury remains the major cause of death and disability worldwide, and places an enormous burden on countries with limited resources in which Ethiopia is included.It is obvious that pre-hospital care is a essential part of the treatment process in many acute disease and trauma.Cross sectional study design using structured interviewing questionnaire which was conducted in 437 Trauma patients who came to emergency department of Tikur Anbesa Specialized Hospital from February 1 to March 30, 2013.Only 73 (16.7%) patients got some kind of basic cars like stop bleeding, positioning, immobilization by ambulance staff 41 (51.2%), relatives 24 (30%) and police and bystanders 14 (20.3%). Commonest means of transportation in which 59% of cases arrived by taxi while about 14.4% were brought in by ambulance. Most patients arrived to definitive care from the scene after are (the golden) hour of injury, has passed; only 81 (18.5%) of patients arrived in less than and within one hour.Proportion of patients, who received care before they arrived in the hospital was very small. Time of arrival to definitive care was prolonged and use of ambulances for transportation was minimal.

Tracheo-innominate artery fistula (TIAF) is a potentially lethal but rare complication associated with tracheostomy. As tracheostomies are one of the common life saving procedures that are performed routinely in the country, bring this complication to the attention of all health care professionals is of paramount importance. Hence, this case report is prepared.

Neural tube defects (NTDs), one of the most common congenital malformations, are potentially preventable cause of perinatal morbidity and mortality.To give baseline description of NTDs and their outcome at two teaching hospitals in Addis Ababa, Ethiopia.A retrospective cross sectional descriptive study conducted from September 2009 to August 2012.During the study period out of 28,961 deliveries 177 cases of NTDs were identified, giving an overall NTD prevalence of 6.1/1000. Only 12% (21/177) were diagnosed before 28 weeks of gestation. The mean gestational age at diagnosis of NTDs was 33.8 weeks (±5.5). Majority, 93.2% (165/177), had antenatal care (ANC) follow-up. Most, 72% (127/177), were diagnosed by ultrasound before delivery while 28% (50/177) were identified at the time of delivery or expulsion. Majority, 85.3% (151/177), never received folic acid supplementation. Only less than 1% (2/177) of the mothers started taking folic acid supplementation pre-conceptionally. Only a third, 33.3% (59/177), of the fetuses were born alive while only 13.6% (24/177) were discharged alive. Myelomeningocele, identified in 51.4% (91/177), was the commonest NTD in this study.The proportion of NTDs in this study is among the highest globally reported rates. The practice of periconceptional folic acid supplementation is negligible. And although most had ANC follow-up the vast majority of NTDs were diagnosed late in the third trimester. It is, therefore, highly recommended to consider implementing national preventive strategies to reduce the prevalence of NTDs in Ethiopia.

Hepatocellular carcinoma (HCC) is a major cause of cancer death worldwide accounting for over half a million deaths per year. Hepatocellular carcinoma can occur secondary to viral hepatitis, HBV or HCV. It can also occur secondary to other causes of Cirrhosis (alcoholism being the other most common cause).To describe clinical and laboratory characteristics of Hepatocellular carcinoma in a tertiary care hospital in Addis Ababa, Ethiopia.A retrospective study was conducted in patients admitted to Tikur Anbassa specialized Hospital with a diagnosis of Hepatocellular carcinoma during the period of January 1, 2013 to Dec. 31, 2015. Data were collected using structured questionnaire on basic demographic factors, behavioral risks, laboratory profiles and imaging reports. Descriptive analysis was performed on the data collected.Fifty one patients fulfilled the criteria for Hepatocellular carcinoma in the study period. Thirty nine were males and 12 were females. Hepatitis B and C viruses were found to be the causes for HCC in 48% of the cases. History of alcohol abuse was documented in 45% % of the individuals. About 26% of the patients had Ascites, 35% were found to have portal vein thrombosis, The child-Pugh score for patients who had complete profile were Child A 46%, Child B an equal percentage of 46% andfor Child C 0.7%.The contribution of Hepatitis virus is high with equivalent proportion of HBV and HCV. Alcohol intake and unidentified risk factors have also played for another half of the causes. Almost a third of patients have Portal vein thrombosis and 96% were either Child Pugh A or B. Enhancing immunization coverage frequent use of infection prevention and availability of treatment for viral hepatitis will help to reduce Hepatocellular carcinoma.

Only 41% of eligible Ethiopian women completed (PMTCT) therapy in 2012, with MTCT rate of 20%.This study elicited the perspectives of HIV positive mothers on the situation and the unique beliefs, attitudes, cultural norms and individuals who have influence over them during their pregnancy.The mixed-methods parent study included community level surveys, focus groups and in-depth individual interviews of HIV positive women with a child at least one year of age in Addis Ababa, Ethiopia: only focus group and interview data are presented here. All tools were completed in Amharic with English translation.23 women completed in-depth interviews; 27 participated within 4 focus groups. The greatest barriers to PMTCT completion were: feelings of hopelessness and carelessness, lack of understanding of the efficacy of ARV, and negative religious influences. The advice to improve PMTCT adherence most frequently offered included increasing PLWHIV peer support and improving and extending current HIV educational efforts. Participants recommended that PLWHIV mothers be utilized in all PMTCT planning and interventions in the future.Maintaining the motivation to adhere to the entire PMTCT cascade requires that a PLWHIV mother understands the validity of the steps she is taking and receives support for the many challenges she faces. Engaging PLWHIV peers as active members of the health care workforce and expanding their use as educators and counselors is important. Health officials can consider these findings to develop innovative and effective PMTCT interventions.