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BACKGROUND: Acute coronary syndrome (ACS) is a lifethreatening condition. The mortality rate will be reduced if immediate treatment is provided. Patients' awareness of ACS is limited, so they do not seek help as quite often as they should. The level of treatment seeking behavior and associated factors among ACS patients admitted to three hospitals in Addis Ababa, Ethiopia, were assessed using a health belief model.METHODS: A cross-sectional study was conducted among 330 ACS patients from November 2019 to December 2020. Sociodemographic and clinical variables data were extracted using pre-tested checklist. The outcome and other variables data were collected using the checklist and structured questionnaire. The data were entered into Epi-data 3.1 and exported to STATA 17.1 for analysis. Descriptive statistics relevant to the variable wasperformed. A multivariable logistic regression was used to identify factors associated with treatment seeking behavior.RESULTS: This study revealed that the mean time from symptom onset to arrival at the emergency unit (EU) was 24 ± 19.5 hours, slightly < half of the participants (n=149, 45.1 %) had adequate treatment seeking behavior. Perceived threat (AOR=1.03,95% CI:1.01-1.06, p=0.002), perceived benefits (AOR=1.09, 95%CI: 1.02-1.0, p≤0.001), self-efficacy (AOR=1.16, 95% CI :1.01- 1.22, p≤ 0.001), education (AOR=2.2,95%CI:1.31-3.9, p≤0.01) selfautonomy (AOR=3.1,95%CI:1.82-5.4, p

Micheal Alemayehu,1,2 Aklilu Azazh,2 Heyria Hussien,2 Ararso Baru3 1Department of Emergency and Critical Care, Tiruneshi Beijing General Hospital, Addis Ababa, Ethiopia; 2Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Nursing, College of Health Sciences, Arba Minch University, Arba Minch, EthiopiaCorrespondence: Micheal Alemayehu, Email amic8593@gmail.comIntroduction: Mechanical ventilation is the primary method of supporting organ function for patients admitted to intensive care units (ICU). The information on the characteristics and outcomes of patients requiring mechanical ventilation is essential to understanding the causes of mortality among mechanically ventilated patients. However, the available literature in developing countries, including Ethiopia, is limited.Objective: The objective of this study was to assess the characteristics and outcomes of mechanically ventilated patients in adult intensive care units in selected public hospitals, in Addis Ababa, Ethiopia, from 2019 to 2020.Methods: An institutional-based cross-sectional study design was employed. All adult patients who were mechanically ventilated and admitted to ICU for at least 24 hours between July 2019 and July 2020 were included in the study. The collected data were evaluated with SPSS version 26 software. Multiple logistic regression models were used to indicate the association between dependent and independent variables. The variables, which have an independent association with poor outcomes, were identified with a p-value less than 0.05.Results: Of 180 mechanically ventilated patients, 98(54.4%) were male. The main reason for ventilation was respiratory failure. The mean duration of stay on the ventilator was 7.09± 6.06, and the mortality rate in mechanically ventilated patients was 41.7%. The mortality rate was higher in patients with cardiac diseases 43(57.70%). Inotropic use, not taking sedation, and length of stay on a mechanical ventilator were independently associated with mortality.Conclusion: The mortality rate of mechanically ventilated patients in the selected public hospitals was high. The clinicians must strive to balance the necessity and benefit of sedation use with the potential to negatively affect the patient outcome. In addition, the risk:benefit assessment of ventilation must be done for all patients requiring ventilator support.Keywords: mechanical ventilation, intensive care unit, characteristics, outcome, Ethiopia

BACKGROUND፡ Evidence-base practice needs to be supported by guidelines and decision-making protocols. This study aimed to look into the barriers and facilitators of adherence to national protocols in Ethiopia.METHODS: Exploratory qualitative method was implemented to explore adherence to protocol. The national COVID-19 case management guideline was used as this study's prototype reference. A total of five FGDS were conducted among 26 healthcare providers. A total of 14 physicians and 12 nurses participated in the FGDs. Semi-structured focus group discussions guides were used to facilitate the discussion among healthcare workers involved in COVID-19 case management. The FGDs were audio recorded, transcribed and analyzed thematically.RESULTS: Three broad themes have emerged from the content analysis. These include individual factors, environmental factors and system factors. System factors barriers to utilization include unclear guidelines, discordant guidelines and a lack of live national guidelines, while the main facilitator was supportive management. The environmental factors that were barriers to adherence included limited infrastructure and shortages of drugs suggested in the protocols.CONCLUSION: Outdated and discordant guidelines and a shortage of suggested managements were barriers. Future similar works should consider the identified barriers and need regular updates to facilitate effective implementation.

BackgroundEmpirical treatment of infections remains a major contributing factor to the emergence of pathogens that are resistant to antibiotics. The study aimed to assess the prevalence and anti-microbial sensitivity patterns of uropathogens in the emergency center of Tikur Anbessa Hospital, Ethiopia.MethodsUrine sample data collected over two years from January 2015 to January 2016 at Tikur Anbessa Hospital’s laboratory were retrospectively analyzed for bacterial pathogens, and their antimicrobial susceptibility. Antimicrobial sensitivity tests were done using the disc diffusion technique as per the standard of the Kirby-Bauer method.ResultOf the total 220 samples that were collected, 50 (22.7%) were culture-positive. Male to female data ratio was 1:1.1. Escherichia coli was the dominant isolate (50%) followed by Enterococcus species (12%), Enterobacter species (12%), and Klebsiella species (8%). Overall resistance rates to Cotrimoxazole, Ampicillin, Augmentin, and Ceftriaxone were 90.4%, 88.8%, 82.5%, and 79.3%, respectively. The sensitivity rates for Chloramphenicol, Amikacin, Vancomycin, Meropenem, Cefoxitin, and Nitrofurantoin ranged from 72% - 100%. The antibiogram of isolates showed that 43 (86%) isolates were resistant to two or more antimicrobials, and 49 (98%) were resistant to at least one antibiotic.Conclusion and recommendationUrinary tract infections are mostly caused by Gram-negative bacteria predominantly in females and Escherichia coli are the most common isolates. Resistance rates to Cotrimoxazole, Ampicillin, Augmentin, and Ceftriaxone were high. Chloramphenicol, Amikacin, Vancomycin, Meropenem, Cefoxitin, and Nitrofurantoin are considered appropriate antimicrobials for the empirical treatment of urinary tract infections in the emergency department. Yet, using antibiotics indiscriminately for patients with complicated UTIs may increase the resistance rate and also lead to treatment failure, hence the prescriptions should be revised following the culture and sensitivity results

Background Acute coronary syndrome (ACS) morbidity and mortality are rising in low- and middle-income countries, including Ethiopia. The shift in health-care resources from communicable diseases to chronic conditions has created formidable health-care challenges. Objective The objective of this study was to examine the knowledge, attitudes and beliefs among ACS patients. Methods A cross-sectional design was used to enroll participants admitted to one of 3 emergency units in Addis Ababa, Ethiopia. Knowledge, attitudes and beliefs about ACS was measured using modified ACS response index questionaries. Results Participant’s (N = 330) mean age was 57.9 ± 14.1, majority male (n = 219, 66.36%). Half of the study participants have inadequate Knowledge (n = 147, 44.6%), unfavorable attitudes (n = 152, 46%), and belief (n = 153, 46.4%) about ACS symptoms even after being diagnosed and treated in the emergency unit. The most frequently recognized ACS symptoms were chest discomfort (n = 274, 83%), fatigue (n = 267, 80.9%) and chest pain (n = 266, 80.6%) while Jaw pain (n = 101, 30%) neck pain (n = 146,44.2%), were less often recognized. Nearly two thirds of the participants (n = 214, 65%) would not prefer to use emergency medical services (EMS) to come to the hospital. Factors associated with adequate knowledge were age Conclusion Despite receiving treatment for ACS in an emergency unit, roughly half of participants did not have adequate knowledge, favorable attitude and belief towards ACS. This elucidates there is significant communication gap between the health care providers and patients. The study findings stipulate there is a need to provide health awareness campaigns using different media outlet with special attention to the uneducated and unemployed groups. Furthermore, most participants were less likely to utilize emergency medical service, which should be further investigated and addressed.

Background Despite improvement, sepsis mortality rates remain high, with an estimated 11 million sepsis-related deaths globally in 2017 (Rudd et. al, Lancet 395:200-211, 2020). Low- and middle-income countries (LMICs) are estimated to account for 85% of global sepsis mortality; however, evidence for improved sepsis mortality in LMICs is lacking. We aimed to improve sepsis care and outcomes through development and evaluation of a sepsis treatment protocol tailored to the Tikur Anbessa Specialized Hospital Emergency Department, Ethiopia, context. Methods We employed a mixed methods design, including an interrupted times series study, pre-post knowledge testing, and process evaluation. The primary outcome was the proportion of patients receiving appropriate sepsis care (blood culture collection before antibiotics and initiation of appropriate antibiotics within 1 h of assessment). Secondary outcomes included time to antibiotic administration, 72-h sepsis mortality, and 90-day all-cause mortality. Due to poor documentation, we were unable to assess our primary outcome and time to antibiotic administration. We used segmented regression with outcomes as binomial proportions to assess the impact of the intervention on mortality. Pre-post knowledge test scores were analyzed using the Student’s t-test to compare group means for percentage of scenarios with correct diagnosis. Results A total of 113 and 300 patients were enrolled in the pre-implementation and post-implementation phases respectively. While age and gender were similar across the phases, a higher proportion (31 vs. 57%) of patients had malignancies in the post-implementation phase. We found a significant change in trend between the phases, with a trend for increasing odds of survival in the pre-implementation phase (OR 1.24, 95% CI 0.98–1.56), and a shift down, with odds of survival virtually flat (OR 0.95, 95% CI. 0.88–1.03) in the post-implementation phases for 72-h mortality, and trends for survival pre- and post-implementation are virtually flat for 90-day mortality. We found no significant difference in pre-post knowledge test scores, with interpretation limited by response rate. Implementation quality was negatively impacted by resource challenges. Conclusion We found no improvement in sepsis outcomes, with a trend for increasing odds of survival lost post-implementation and no significant change in knowledge pre- and post-implementation. Variable availability of resources was the principal barrier to implementation. Trial registration Open Science Framework osf.io/ju4ga. Registered June 28, 2017

Background: Understanding the clinical profile and outcome of pediatrics Coronavirus disease 2019 will help plan better prevention and treatment strategies taking the local context into consideration. The aim of the study is to assess the clinical characteristics and outcome of pediatrics COVID 19 patients admitted to Ekka Kotebe treatment center from March 20, 2020, to August 20, 2020 Method: This retrospective study included all children in Addis Ababa who tested positive for COVID-19 and were admitted at Ekka Kotebe treatment center from March to August 2020. The data was collected from the patient records of the participants who fulfilled the inclusion criteria. The collected data was analyzed using SPSS for windows version 25. The sociodemographic, clinical presentation and their outcome was analyzed using descriptive analysis for each data was done. The finding was presented in tables and graph. Result: A total of 87 children were included in the study, of these 71 (81.6%) were from Addis Ababa. 64.8% (n = 57) of participants were male with a mean age of 10.8years while 11% (n = 10) were infants. About 45.5% (n = 40) had history of household contact. Comorbidities were noted in 10.3% (n = 9) children. More than two third (72.7 %, n = 64) of participants were asymptomatic. Of the 23 symptomatic children, fever (65%, n = 15) was most common followed by cough (6.8%, n = 6), sore throat (2.3%, n = 2). 69.3% (n = 61) stayed for more than 14 days but one of the participants had a fatal outcome. Conclusion: Important number of children with COVID-19 had a household contact and presented asymptomatic or with a mild illness. Severe and critical illness were observed in those with comorbidity.

Additional file 1.TIDieR checklist.

Introduction In Ethiopia, the specialty of Emergency Medicine is a relatively new discipline. In the last few decades, policymakers have made Emergency Medicine a priority for improving population health. This study aims to contribute to this strengthening of Emergency Medicine, by conducting the country’s first baseline gap analysis of Emergency Medicine Capacity at the pre-hospital and hospital level in order to help identify needs and areas for intervention. Methods This is a cross sectional investigation that utilized a convenience sampling of 22 primary, general and tertiary hospitals. Trained personnel visited the hospitals and conducted 4-hour interviews with hospital administrators and emergency care area personnel. The tool used in the interview was the Columbia University sidHARTe Program Emergency Services Resource Assessment Tool (ESRAT) to evaluate both emergency and trauma capacity in different regions of Ethiopia. The findings of this survey were then compared against two established standards: the World Health Organization’s Essential Package of Emergency Care (EPEC), as well as those set by Ethiopia’s Federal Ministry of Health. Results The tool assessed the services provided at each hospital and evaluated the infrastructure of emergency care at the facility. Triage systems differed amongst the hospitals surveyed though triaging and emergency unit infrastructures were relatively similar amongst the hospitals. There was a marked variability in the level of training, guidelines, staffing, disaster preparedness, drug availability, procedures performed, and quality assurance measures from hospital to hospital. Most regional and district hospitals did not have nurses or doctors trained in Emergency Medicine and over 70% of the hospitals did not have written guidelines for standardized emergency care. Conclusion This gap analysis has revealed numerous inconsistencies in health care practice, resources, and infrastructure within the scope of Emergency Medicine in Ethiopia. Major gaps were identified, and the results of this assessment were used to devise action priorities for the Ministry of Health. Much remains to be done to strengthen Emergency Medicine in Ethiopia, and numerous opportunities exist to make additional short and long-term improvements.

BackgroundAcute kidney injury (AKI) is a major health problem, causing morbidity in 13 million people annually, among which, 85% occur in developing countries. It is, therefore, one of the important issues in Africa where there is resource limitation at large, and appreciation of its pattern can help understand its causes, complications, and outcome better which are determinants for its early prevention and management. The objective of the study was to evaluate Patterns and outcomes of AKI patients who are admitted to the Tikur Anbessa specialized hospital (TASH) Adult Emergency Unit, Addis Ababa, Ethiopia. MethodsA prospective Cross-sectional study was done from August 1, 2018, to May 1, 2019. . A total of 144 cases of AKI were included in the study. Binary logistic regression was done for the identification of mortality predictors. Patients’ laboratory results on admission and discharge were compared by paired samples T-test. Survival time was estimated by Kapan- Meier and Log Rank Test with a 95% CI. ResultsThe mean age of presentation at a younger age of 46.16 ± 16.6, the most common causes of AKI were Sepsis (43.2%), volume depletion (25%), cardiorenal syndrome (16%), and obstructive uropathy (16%). Uremic encephalopathy, sepsis, and hyperkalemia were factors that were identified as mortality predictors in overall AKI patients.ConclusionAKI patients with sepsis were found to have lower hospital survival than those without sepsis. From the laboratory findings, there was a significant difference between creatinine values on admission and discharge.

Background Consistent data on head injury is lacking especially in the low- and middle-income countries. Our study tries to characterize patients with head injury at the emergency department of one of the few tertiary public hospitals giving neurosurgical care in the country. Methods A retrospective cross-sectional study was performed from May 2015 to October 2015 in one of the neurosurgical teaching hospitals, Black Lion Specialized Hospital. All adult patients with head injury who visited the emergency department during the study period were included. Data on patients' sociodemographic, mechanism of trauma, clinical presentation, imaging findings, and presence of polytrauma were collected by a pretested questionnaire. The source of data was emergency department logbooks and patient charts. Results A total of 390 patients with head injury who visited the emergency department were included during the study period. There were 335 males (85.9%) and 55 females (14.1%) with the mean age (standard deviation) of 35.4 (15.6) years. Majority of patients came by taxi constituting 149 (38.2%) of all patients, whereas 147 patients (37.7%) used ambulance. Of 147 patients brought by ambulances, 133 (90.4%) were referred from other hospitals. The majority, 26 (45.6%), of patients who came directly to the emergency department used taxis. It is shown that the mode of arrival and origin of arrival are significantly related, P = 0.000. Mortality of severe head injury at the emergency department was 50.8%. Conclusions Prehospital care coverage was low and ambulances were used mainly for interhospital transfers. Mortality of severe head injury at the emergency department is high and significantly associated with preventable causes like vital sign derangement.

Background Globally, about 1.25 million people die annually from road trafficcollisions. Evidence from global safety report shows a decreasing trend of road traffic injury indeveloped countries while there is an increasing trend in many developing countriesincluding Ethiopia. This study is aimed at assessing factors affecting injury severity levels of road traffic collision victims referred to selected public hospitals in Addis Ababa based on the Haddon Matrix. Methods Ahospital-based cross-sectional study designwas implemented to randomly select a total of 363 road traffic collision victims. The collected data was cleaned andentered into Epidata version 3.1 and exported to SPSS Version 21 for analysis. Bivariate and multivariate logisticregression models were used to examine the association between explanatory and outcome variables. Results A total of 363 individual sustained road traffic injuries were included to the study. Theprevalence of severe injury among road traffic accident victims was 36.4%. The following variables were significantly associated with increased injury severity: motorbike rider or motorbike passenger without helmet, adjusted odds ratio (AOR) 4.7(95% CI: 1.04–21.09); driving under the influence of alcohol, crude odds ratio (COR) 2.64(95% CI;1.23–5.64); victim with multiple injuries, AOR 3.88(95% CI: 2.26–6.65); vehicle size, AOR 2.14(95% CI: 1.01–4.52); collision in dark lighting condition, AOR 1.93(95% CI: 1.01–3.65); collision in cross city/rural, AOR 1.95(95% CI: 1.18–3.24) and vehicle occupant travelling unrestrained on the back of a truck, AOR3.9 (95% CI: 1.18–12.080). On the other hand, victims extricated at the scene by health care professional, AOR 0.33(95% CI: 0.13–0.83); victims extricated at the scene by police AOR 0.47(95% CI: 0.24–0.94); strict traffic police control at the scene of the collision, AOR 0.49(95% CI: 0.27–0.88) were significantly associated with less severe injuries. Conclusions Findings reported in this paper suggest the need forimmediate and pragmatic steps to be taken to curb the unnecessary loss of livesoccurring on the roads. In particular, there is urgent need to introduce road safety interventions.

BACKGROUND: Since the occurrence of COVID-19 in the world, it has claimed nearly 1.39 million human lives in the world and more than 1500 lives in Ethiopia. The number of deaths is increasing with variable distribution in the world. Despite its increasing fatality, the clinical characteristics of the deceased patients are not yet fully known. Analyzing the clinical characteristics of deceased patients will help to improve the outcome of infected patients. Hence, this study aimed to determine the clinical characteristics of patients who died due to COVID-19 in Ethiopia.METHODS: Hospital based multi-center cross-sectional study was conducted using chart review of deceased patients. Since the number of COVID-19 related deaths was limited, all consecutive COVID-19 related hospital deaths were analyzed. The data was entered into and analyzed using SPSS version 25.0. Descriptive statistics was used to explain the data collected from the survey.RESULT: A total of 92 deceased patient charts were analyzed. Of these patients, 65(71%) were males. Age ranged from 17 to 92 years (mean age being 59 years). On arrival vital signs, 60.5% of them had hypoxia, 49% had tachycardia and only 32% of patients had fever. Three fourth of the patients 64/85 had at least one comorbidity. Diabetes mellitus (DM) was the commonest comorbidity accounting for 445.9%, followed by hypertension, 23/85(27%), and HIV/ AIDS, 15/85 (17.5%).CONCLUSION: The results of this study showed that COVID-19 deceased patients presented with respiratory failure and hypoxia. However, less than a third of these patients had fever. In addition, the presence of comorbid illnesses and non-COVID-19 diseases like AIDS defining illness in significant amount needs further study to identify their level of contribution to the increasing burden of COVID-19 deaths in Ethiopia.