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Menbeu Sultan,1 Lemlem Beza,2 Finot Debebe,2 Getaw Worku Hassen,3 Anisha Duvvi,3 Selamawit Tilahun,4 Nura Nasser,5 Sisay Bekele6 1Department of Emergency Medicine and Critical Care, St. Paul’s hospital millennium medical College, Addis Ababa, Ethiopia; 2Department of Emergency Medicine, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Emergency Medicine, New York Metropolitan Hospital, New York, NY, USA; 4Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 5Department of Anesthesiology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 6Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Menbeu Sultan, Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, Email smenbeu@yahoo.comAbstract: Tracheal masses are rare in occurrence, but could lead to complications depending on the speed of growth, duration and degree of obstruction. Some of the complications are recurrent pneumonia and air trapping resulting in increased intrathoracic pressure. The latter phenomenon can result in obstruction of the venous return and pneumothorax. We are reporting a rare presentation of bilateral pneumothorax (presumed tensioned) in a young patient with a distal obstructive tracheal tumor. In the emergency department (ED) the patient was in respiratory distress and was found to have extensive subcutaneous emphysema of the neck, chest, and abdominal wall with hypotension. Respiratory failure from bilateral tension pneumothorax was suspected and the patient was intubated with simultaneous bilateral thoracostomy. These measures did not improve the patient’s ventilation and oxygenation status. Further fiberoptic investigation revealed a distal tracheal obstructive mass. An emergency surgical intervention was required to remove the tumor. We recommend considering alternative pathologies, such as an obstructive tracheal tumor, in a patient with respiratory distress. They should especially be considered when oxygenation and ventilation are difficult, particularly when endotracheal intubation and/or tube thoracostomy fail to improve the symptoms. A high index of suspicion and a timely multidisciplinary team approach are essential when managing the life-threatening presentation of a patient with a distal tracheal tumor.Keywords: bilateral pneumothorax, tracheal tumor, hypoventilation

Abstract Background Patients with type 2 diabetes mellitus (T2D) have an increased risk of vascular complications. Despite the rise in the prevalence of T2D and its complications throughout the globe, there is a paucity of data regarding the prevalence and determinants of vascular complications of T2D in Ethiopia. Hence, this study aimed to assess the prevalence, patterns, and determinants of the microvascular and macrovascular complications of T2D among adult patients attending a teaching hospital in Addis Ababa, Ethiopia. Methods A retrospective study was done by reviewing the electronic health records of adult patients with T2D attending the general medical and endocrine referral clinics of Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from June 1, 2023, to November 30, 2023. Statistical Package for Social Sciences (SPSS), version 25, was used to analyze the data. Descriptive analysis was used to summarize the sociodemographic, clinical, and laboratory profiles as well as the patterns of vascular complications of T2D. Bivariate and multivariate logistic regression models were fitted, and the crude odds ratio (COR) and adjusted odds ratio (AOR), together with the 95% confidence interval (CI), were computed to identify the determinants of microvascular and macrovascular complications of T2D. Results A total of 272 patients with T2D were included in this study; 50.5% were females, and the mean (± standard deviation) age was 56.3 ± 12.8 years. The majority of patients (62.5%) had diabetes for ≥ 5 years. More than half (51.5%) had poor glycemic control with glycated haemoglobin (HbA1c) value of ≥ 7%. The overall prevalence of vascular complications was 39%. The prevalence of microvascular complications was 23.5%, the most common being neuropathy (11.8%), and the prevalence of macrovascular complications was 21%, the most common being coronary artery disease (12.1%). The determinants of microvascular complications were age ≥ 60 years (AOR = 2.25, 95% CI: 1.17, 4.33), diabetes duration of ≥ 5 years (5–10 years [AOR = 3.13, 95% CI: 1.37, 7.18], and > 10 years [AOR = 3.88, 95% CI: 1.66, 9.06], and HbA1c value of ≥ 7% (AOR = 2.21, 95% CI: 1.14, 4.28). The odds of developing macrovascular complications were higher with diabetes duration of ≥ 5 to 10 years (AOR = 2.89, 95% CI: 1.37, 6.12) as compared with diabetes duration of

Abstract Background Prader–Willi syndrome is a complex multisystem disorder due to the absent expression of paternally active genes in the Prader–Willi syndrome-critical region on chromosome 15 (15q11.2-q13). The main clinical features are hyperphagia (which frequently results in early-onset obesity), hypogonadism, developmental delays, typical behaviors (such as obsessive–compulsive tendencies, tantrums, perseveration, insistence on sameness, and rigidity), and distinctive facial features. In infants, the most prominent findings are hypotonia and feeding difficulties. Case presentation This paper highlights a case of a 14 year old male patient of an Ethiopian ethnicity with diagnosis of Prader–Willi syndrome, which is first report in Ethiopia. He presented with progressive excessive weight gain, insatiable appetite, clinical and laboratory features of hypogonadism, ophthalmological refractory error, and facial features of Prader–Willi syndrome, which was further confirmed by genetic analysis. He is currently on lifestyle intervention, testosterone replacement, and treatment for vitamin D deficiency. Conclusion Prader–Willi syndrome should be considered in a child who presents with progressive weight gain and other typical clinical features such as cognitive impairment, excessive insatiable eating, or hypothalamic hypogonadism. Early lifestyle intervention may help to reduce excessive weight gain. To our knowledge, this is the first case reported in Ethiopia.

Severe insulin resistance is defined as the need of insulin requirement of more than two units per kilogram of body weight. It is rarely seen in diabetic patients. Common causes of severe insulin resistance include severe insulin resistance syndromes, drugs, endocrine disorders, factitious causes, lipodystrophy, increased insulin clearance, and impaired insulin absorption. Here, we describe a diabetic patient with major depressive disorder who was prescribed a maximum of 282 units (4.9 units/kg) of insulin a day. However, the cause in this patient was pseudo-resistance to insulin due to the inappropriate use of insulin by the patient. The ability to maintain her glycemia in the target range with lower doses of insulin was confirmed after the patient was admitted to the hospital. It is, therefore, crucial to systematically address any patient who requires an exceptionally high dose of exogenous insulin, starting with technical issues (injection technique, site of administration, or insulin storage), medication adherence, or medication errors.

Abstract In this paper, we use the concept of an intuitionistic fuzzy set to PMS-ideals in PMS-algebras. We discuss the notion of intuitionistic fuzzy PMS-ideals under homomorphism and Cartesian product and investigate several related properties. The homomorphism of an intuitionistic fuzzy PMS-ideal of a PMS-algebra is studied, and its homomorphic image and inverse image are investigated. The Cartesian product of any two intuitionistic fuzzy PMS-ideals is discussed, and some related results are obtained. The Cartesian product of the intuitionistic fuzzy PMS-ideals is characterized in terms of their level sets. Finally, we discuss the concept of the strongest intuitionistic fuzzy relations on an intuitionistic fuzzy PMS-ideal of a PMS-algebra and investigate the relationships between the strongest intuitionistic fuzzy relations and the intuitionistic fuzzy PMS-ideals.

In this paper, we introduce the notion of intuitionistic fuzzy PMS-subalgebras under homomorphism and Cartesian product and investigate several properties. We study the homomorphic image and inverse image of the intuitionistic fuzzy PMS-subalgebras of a PMS-algebra, which are also intuitionistic fuzzy PMS-subalgebras of a PMS-algebra, and find some other interesting results. Furthermore, we also prove that the Cartesian product of intuitionistic fuzzy PMS-subalgebras is again an intuitionistic fuzzy PMS-subalgebra and characterize it in terms of its level sets. Finally, we consider the strongest intuitionistic fuzzy PMS-relations on an intuitionistic fuzzy set in a PMS-algebra and demonstrate that an intuitionistic fuzzy PMS-relation on an intuitionistic fuzzy set in a PMS-algebra is an intuitionistic fuzzy PMS-subalgebra if and only if the corresponding intuitionistic fuzzy set in a PMS-algebra is an intuitionistic fuzzy PMS-subalgebra of a PMS-algebra.

This study seeks to understand how the intersection of migration, gender, and age shapes the marital prospects of Ethiopian female domestic workers returning from the Arabian Gulf and the Middle East. The study found that gendered attitudes in Ethiopian society rooted in patriarchy interact with age and the migration experiences of returnees to create stigma and marginalization, excluding the returnees from the highly desired social institution of marriage. It was also found that returnees tended to dissociate themselves from other returnees or kept their experiences secret to cope with stigma and marginalization and increase their marital prospects. The study shows how the stigma and marginalization experienced by Ethiopian female returnees from the Arabian Gulf and Middle East countries affects their social reintegration in the home country and can trigger remigration intention. [ABSTRACT FROM AUTHOR]

A large number of unskilled women from least developed countries engage in international migration as domestic workers. Although the transnational migration experiences of these women could potentially be empowering, women migrants are vulnerable to exploitation. This paper explores the migration experiences of Ethiopian women who migrate to Arabian Gulf countries as domestic workers under the kafala labor sponsorship system and how they cope with their traumtic experiences upon return to Ethiopia. Forty-eight women Ethiopian former domestic workers who had returned from Arabian Gulf countries participated in this study. The study found that both women migrants who live with their sponsor/employer and those who run away from their sponsor/employer are exposed to various forms of racialized, gendered and economic exploitation at different stages of the migration process. The study also found that upon returning to Ethiopia, these women use sense-making and benefit-finding strategies to cope with their multiple exploitation experiences. [ABSTRACT FROM AUTHOR]

In this article, we apply the concept of a t-intuitionistic fuzzy set to PMS-ideals in PMS-algebras. The notion of the t-intuitionistic fuzzy PMS-ideal of PMS-algebra is introduced, and several related properties are studied. The relationships between a t-intuitionistic fuzzy PMS-ideal and a t-intuitionistic fuzzy PMS-subalgebra of a PMS-algebra, as well as the relationships between an intuitionistic fuzzy PMS-ideal and a t-intuitionistic fuzzy PMS-ideal are discussed in detail. A condition for an intuitionistic fuzzy set to be a t-intuitionistic fuzzy PMS-ideal is provided. The t-intuitionistic fuzzy PMS-ideals of PMS-algebra are described using their α,β level cuts. The homomorphism of a t-intuitionistic fuzzy PMS-ideal of a PMS-algebra is studied, and its homomorphic image and inverse image are explored. The Cartesian product of any two t-intuitionistic fuzzy PMS-ideals is discussed, and some related results are derived. The Cartesian product of the t-intuitionistic fuzzy PMS-ideals is also characterized using its α,β level cuts. The strongest t-intuitionistic fuzzy PMS-relation in a PMS-algebra is defined. Finally, the relationships between the strongest t-intuitionistic fuzzy PMS-relation and t-intuitionistic fuzzy PMS-ideal are studied.

Background: Optimizing the performance level of nursing staff is crucial for the efficient functioning of hospitals and better patient health outcomes. However, published data on the job performance levels and associated factors of nurses in Ethiopia is limited. Therefore, this study aimed to assess the job performance and associated factors of nurses working in adult emergency departments at selected public hospitals in Addis Ababa, Ethiopia., Methods: A facility-based cross-sectional study was conducted from March 25 to April 25, 2023, among 172 nurses working in the adult emergency departments of selected public hospitals in Addis Ababa, Ethiopia. A simple random sampling technique was used to select the study participants. Data were collected using pretested, self-administered structured questionnaires. Data were coded, entered into Epi-data version 4.6, and analyzed using Statistical Package for Service Solution (SPSS) Version 27.0.1 software. Data were summarized using descriptive statistics, including mean, frequency, and standard deviation. A binary logistic regression analysis was done to determine factors associated with the performance of nurses. The strength of the association was measured using an adjusted odd ratio (AOR) with a 95% confidence interval (CI), and a P-value < 0.05 was considered statistically significant., Results: The majority of nurses, 70.5% (95% CI: 63.7-77.3), rated their job performance as good. Workload [AOR = 1.70 (95% CI: 1.19-2.44)], remuneration [AOR = 1.89 (95% CI: 1.35-2.67)], rewards [AOR = 1.50 (95% CI: 1.01-2.23)], objectives to be achieved [AOR = 1.88 (95% CI: 1.32-2.67)], and feedback on performance appraisals [AOR = 1.65 (95% CI: 1.17-2.33)] were identified as significantly associated with nurses' performance., Conclusion: While the majority of nurses rated their job performance as good, it is important to note that a relevant proportion of nurses rated their job performance as poor. The findings of this study identified that nurses' performance is influenced by several key factors, including workload, remuneration, rewards, objectives to be achieved, and feedback on performance appraisals. Our findings call for improving nurses' job performance; therefore, hospitals should consider implementing systems that effectively utilize performance appraisal results and recognize and encourage hardworking nurses., (© 2024. The Author(s).)

Introduction: Emergency department (ED) overcrowding has become a significant concern as it can lead to compromised patient care in emergency settings. Various tools have been used to evaluate overcrowding in ED. However, there is a lack of data regarding this issue in resource-limited countries, including Ethiopia. This study aimed to validate NEDOCS, assess level of ED overcrowding and identify associated factors at HARME Medical Emergency Center, located in Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia., Methods: A cross-sectional study was conducted at the HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, involving a total of 899 patients during 120 sampling intervals. The area under the receiver operating characteristic curves (AUC) was calculated to evaluate the agreement between objective and subjective assessments of ED overcrowding. A multivariable logistic regression analysis was employed to identify factors associated with ED overcrowding and statistically significant association was declared using 95 % confidence level and a p-value < 0.05., Results: The interrater agreement showed a strong correlation with a Cohen's kappa (κ) of 0.80. The National Emergency Department Overcrowding Study Score demonstrated a strong association with subjective assessments from residents and case team nurses, with an AUC of 0.81 and 0.79, respectively. According to residents' perceptions, ED were considered overcrowded 65.8 % of the time. Factors significantly associated with ED overcrowding included waiting time for triage (AOR: 2.24; 95 % CI: 1.54-3.27), working time (AOR: 2.23; 95 % CI: 1.52-3.26), length of stay (AOR: 2.40; 95 % CI: 1.27-4.54), saturation level (AOR: 2.35; 95 % CI: 1.31-4.20), chronic illness (AOR: 2.19; 95 % CI: 1.37-3.53), and abnormal pulse rate (AOR: 1.52; 95 % CI: 1.06-2.16)., Conclusion: The study revealed that ED were overcrowded approximately two-thirds of the time., Competing Interests: The authors declared no conflicts of interest., (© 2023 The Authors. Published by Elsevier B.V. on behalf of African Federation for Emergency Medicine.)

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., (© 2023 Menberu Sultan, et al.)

The majority of populations in developing countries are living in areas of no access or limited access to prehospital emergency medical services (EMS). In Addis Ababa, the reported prehospital EMS utilization were ranging from zero to thirty-eight percent. However, there is limited research on reasons for the low utilization of prehospital resources in Ethiopia. This study aimed to assess factors associated with prehospital EMS utilization among critically ill COVID-19 patients in Addis Ababa, Ethiopia. A hospital-based cross-sectional study was conducted to collect primary data from 421 COVID-19 patients in Addis Ababa between May and July 2021. Logistic regression was used to identify factors associated with prehospital service utilization. Andersen's Behavioral Model was implemented to address independent variables, including predisposing, enabling, need, and health behaviors-related variables. The level of prehospital care utilization was 87.6%. Being married [AOR 2.6(95%; CI:1.24-5.58)], belief that self-transport is quicker than the ambulance [AOR 0.13(95%; CI: 0.05-0.34)], and perceptions that ambulance provides transportation service only [AOR 0.14(95%; CI:0.04-0.45)] were predisposing factors associated with prehospital service utilization while the source of referrals [AOR 6.9(95%; CI: 2.78-17.30)], and prior knowledge on the availability of toll-free ambulance calling numbers [AOR 0.14(95%; CI: 0.04-0.45)] were identified as enabling factors. Substantial proportions of critically ill COVID-19 patients used prehospital services to access treatment centers. Prehospital EMS utilization in this study varies by predisposing and enabling factors, particularly: marital status, source of referral, prior knowledge on the availability of toll-free ambulances, belief that self-transport is quicker than ambulances, and perceptions that ambulance provides transportation service only. Our findings call for further actions to be taken by policymakers including physical and media campaigns focusing on the identified factors., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Olani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The availability of emergency care contributes to half of the total mortality burden in a low and middle income countries. The significant proportion of emergency departments in LMICs are understaffed and poorly equipped. The purpose of this study is to examine the status of emergency units and to describe the facilitators and barriers to the provision of facility-based emergency care at selected Ethiopian public hospitals., Methods: A mixed-methods explanatory design was used. Ten hospitals were purposively selected due to their high number of patients and referral service. A WHO facility assessment tool was used to quantitatively assess the facilities, and an in-depth interview with hospital and emergency room leadership was conducted. The quantitative results were descriptively analyzed, and the qualitative data was thematically analyzed., Result: This survey included a total of ten hospitals. Three of the facilities were general hospitals, and seven were tertiary level hospitals. They all were equipped with an emergency room. All of the studied hospitals serve a population of over one million people. In terms of infrastructure, only 3/10 (30%) have adequate water supply, and alf (5/10) have telephone access in their ED. The qualitative resultshowedthat the most common barriers to emergency care delivery were prolonged patient stays in the emergency room, inadequate equipment, and a shortage of trained professionals., Conclusion: The status of emergency care in Ethiopia is still developing, and hospital care as a whole should improve to alleviate the high burden of care in emergency rooms and reduce morbidity and mortality., (© 2022 Menbeu S., et al.)

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., (© 2022. The Author(s).)

Background: Acute coronary syndrome (ACS) is a life-threatening 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 was performed. 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) self-autonomy (AOR=3.1,95%CI:1.82-5.4, p<.001) and no depression (AOR=1.9,95%CI:1.1-3.3, p≤0.05) were found to have significantly association with adequate treatment seeking behavior., Conclusion: This study indicates, less than half of ACS patients had adequate treatment seeking behavior. Thus, context-specific behavioral interventions, along with public awareness campaigns about ACS, should be implemented., (© 2022 Lemlem Beza, et al.)

Background: COVID-19 patients may require emergency medical services for emergent treatment and/or transport to a hospital for further treatment. However, it is common for the patients to experience adverse events during transport, even the shortest transport may cause life-threatening conditions. Most of the studies that have been done on prehospital care of COVID-19 patients were conducted in developed countries. Differences in population demographics and economy may limit the generalizability of available studies. So, this study was aimed at investigating the status of prehospital care delivery for COVID-19 patients in Addis Ababa focusing on adverse events that occurred during transport and associated factors., Methods: A total of 233 patients consecutively transported to Saint Paul's Hospital Millennium Medical College from November 6 to December 31, 2020, were included in the study. A team of physicians and nurses collected the data using a structured questionnaire. Descriptive statistics were used to summarize data, and ordinal logistic regression was carried out to assess the association between explanatory variables and the outcome variable. Results are presented using frequency, percentage, chi-square, crude and adjusted odds ratios (OR) with 95% confidence intervals., Results: The overall level of adverse events in prehospital setting was 44.2%. Having history of at least one chronic medical illness, [AOR3.2 (95%; CI; 1.11-9.53)]; distance traveled to reach destination facility, [AOR 0.11(95%; CI; 0.02-0.54)]; failure to recognize and administer oxygen to the patient in need of oxygen, [AOR 15.0(95%; CI; 4.0-55.7)]; absent or malfunctioned suctioning device, [AOR 4.0(95%; CI; 1.2-13.0)]; patients handling mishaps, [AOR 12.7(95%; CI; 2.9-56.8)] were the factors associated with adverse events in prehospital transport of COVID-19 patients., Conclusions: There were a significant proportion of adverse events in prehospital care among COVID-19 patients. Most of the adverse events were preventable. There is an urgent need to strengthen prehospital emergency care in Ethiopia by equipping the ambulances with essential and properly functioning equipment and trained manpower. Awareness creation and training of transport staff in identifying potential hazards, at-risk patients, adequate documentation, and patient handling during transport could help to prevent or minimize adverse events in prehospital care., Competing Interests: The authors declare that they have no competing interests.

Although morbidity and mortality rates are declining for acute coronary syndrome (ACS) in most high-income countries, it is rising at an alarming pace for low to middle income countries (LMICs). A major factor that is contributing to the poor clinical outcomes among LMICs is largely due to prehospital treatment delays. This systematic review was conducted to determine the mean length of time from symptom onset to treatment in LMICs and the sociodemographic, clinical and health system characteristics that contribute to treatment delays. We conducted a comprehensive review of the relevant literature published in English between January 1990 through May 2020 using predefined inclusion and exclusion criteria. Twenty-nine studies were included and time to treatment was defined from ACS symptom onset to first medical contact and dichotomized further as less than or >12-hours. The mean time from symptom onset to first medical contact was 12.7 h which ranged from 10-minutes to 96 h. There was consensus among studies that being older, female, illiterate, living in a rural area, and financially limited was associated with longer treatment delays. Lack of a developed emergency transportation system, poor communication and organization between community facilities and interventional facilities were also cited as major contributors for ACS treatment delays. Findings from this systematic review provide future directions to potentially reduce prehospital delays in LMICs and improve ACS outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

The aetiology of diarrhoea with Cryptosporidium species and pathogenic bacteria has not been identified in the Ethiopian primary healthcare system. Thus, antibiotic consumption for unconfirmed pathogenic diarrhoea is not infrequent. A total of 344 children aged <5 years with diarrhoea were included in the present study to determine protozoal or bacterial aetiology and antibiotic use. Overall, 47.1% of children with diarrhoea had either protozoan or bacterial pathogens. The prevalence of Cryptosporidium species was 12.8% while bacterial pathogens were 13.1%. Based on direct microscopic stool examination, 77.6% (267/344) of children with diarrhoea were treated with antimicrobials. Of these, 16.7%-51.4% of prescribed antimicrobials were appropriate. None of the children with Cryptosporidium diarrhoea were treated with the appropriate antimicrobial. Enteric bacterial pathogens showed a resistance of 51.6% to cotrimoxazole. Empirical treatments are not appropriate for the majority of child cases of diarrhoea.

Background: Human trafficking is a global human rights violation that has profound health, economic, and social impacts. There has been little investigation of service needs and response options for human trafficking survivors in Ethiopia. The purpose of this study was to understand the potential service needs and response options for human trafficking in Ethiopia from multiple stakeholder perspectives., Methods: We conducted a qualitative needs assessment and used content analysis to analyze individual interviews with key stakeholder groups including service providers, academics, lawyers, and non-government organization (NGO) workers between the summer of 2015 - spring of 2016., Results: In total, 17 individuals participated and content analysis elicited four overarching themes related to post-trafficking needs, including mental health considerations, barriers and facilitators to providing survivor services, survivor service needs, and comprehensive care models., Conclusions: This qualitative needs assessment suggests that trafficking survivors may require professional and community services throughout their trafficking experiences, including medical care, economic and job opportunities, legal advocacy, and mental health services. Interventions should harness preexisting community strengths such as Ethiopia's "social healing system," health extension workers, and mobile technology. Future studies should explore tailored interventions and comprehensive models of care implemented within the pre-existing healthcare, social service, and community structures.

Background: Standard precautions are infection control techniques against pathogenic microorganisms that are present in human blood and can cause disease in humans., Objective: This study aims to assess knowledge and practice of standard precautions against blood borne pathogens among doctors and nurses in adult emergency room, Addis Ababa, Ethiopia., Methods: Institutional based cross sectional study was conducted from February to March 2018. A total of 128 study participants selected from four public hospitals were enrolled in this study. Data were collected using standardized pretested questionnaire and thencoded, entered, checked for completeness, and analyzed using SPSS version-23 statisticalsoftware. Chi-square test was used to measure the association between variables. P values <0.05 were taken as statistically significant., Result: The mean knowledge score of standard precaution measures was 10.3 out of 14 knowledge items. Out of 32 doctors, 93.8% (n=30) have good knowledge and out of 91 nurses, 86.8% (n=79) have good knowledge. The mean practice level of the study subjects was 8.5 out of 12 practice items. Majority (73.6%) of nurses have good practice level than doctors (21.8%). Knowledge level was significantly associated with the presence of infection control officer, infection control guideline, and washing hands before touching patients. Profession, training, and the presence of infection control guideline in emergency room were significantly associated with practice level of respondents (P<0.05)., Conclusion: Both nurses and doctors have good knowledge of standard precaution measures. However, nurses have better practice level than doctors. Orientation during employment and continuous training programs should be provided for the newly employed health workers. In addition sustainable supply systems should be available in each hospital management.

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.

Introduction: The African Federation for Emergency Medicine Trauma Data Project (AFEM-TDP) has created a protocol for trauma data collection in resource-limited settings using a clinical chart with embedded standardized data points that facilitates a systematic approach to injured patients. We performed a process evaluation of the protocol's implementation at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia to provide insights for adapting the protocol to our setting., Methods: During the pilot implementation period, the quality of collected data was assessed. Structured key informant interviews about participant experiences and perceptions of the protocol implementation were then conducted. Interviews were analysed using a SWOT model., Results: During pilot data collection, the overall capture rate was 21%. Variables collected with high frequency included demographics, vital signs and ED diagnosis, while mechanism of injury and ED disposition were often missed. Key informant interviews identified Strengths, Weaknesses, Opportunities and Threats to the protocol. Strengths included improved patient care, enhanced training for junior providers and facilitated data collection. Weaknesses included inadequate supervision and challenges relating to the physical size of the form, which resulted in missing data. Opportunities included retrospective research and quality improvement work. Threats included perceived lack of a local champion, poor buy-in from other hospital departments and need for ongoing financial support., Conclusion: A mixed methods process evaluation is an invaluable tool when implementing novel data collection protocols, especially in resource-limited settings. We determined early successes and challenges of the implementation of the AFEM-TDP protocol and generated strategies to adapt the protocol to better suit our setting. Lessons from this process evaluation may be informative for other researchers designing and implementing similar data collection protocols.

Background: Childhood mortality remains high in resource-limited third world countries. Most childhood deaths in hospital often occur within the first 24 h of admission. Many of these deaths are from preventable causes. This study aims to describe the patterns of mortality in children presenting to the pediatric emergency department., Methods: This was a five-year chart review of deaths in pediatric patients aged 7 days to 13 years presenting to the Tikur Anbessa Specialized Tertiary Hospital (TASTH) from January 2012 to December 2016. Data were collected using a pretested, structured checklist, and analyzed using the SPSS Version 20. Multivariate analysis by logistic regression was carried out to estimate any measures of association between variables of interest and the primary outcome of death., Results: The proportion of pediatric emergency department (PED) deaths was 4.1% (499 patients) out of 12,240 PED presentations. This translates to a mortality rate of 8.2 deaths per 1000 patients per year. The three top causes of deaths were pneumonia, congestive heart failure (CHF) and sepsis. Thirty two percent of the deaths occurred within 24 h of presentation with 6.5% of the deaths being neonates and the most common co-morbid illness was malnutrition (41.1%). Multivariate analysis revealed that shortness of breath [AOR=2.45, 95% CI (1.22-4.91)], late onset of signs and symptoms [AOR=3.22, 95% CI (1.34-7.73)], fever [AOR=3.17, 95% CI (1.28-7.86)], and diarrhea [AOR=3.36, 95% CI (1.69-6.67)] had significant association with early mortality., Conclusion: The incidence of pediatric emergency mortality was high in our study. A delay in presentation of more than 48 hours, diarrheal diseases and shortness of breath were significantly associated with early pediatric mortality. Early identification and intervention are required to reduce pediatric emergency mortality.