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Simegnew Kibret, Diriba Teshome, Efrem Fenta, Metages Hunie, Moges Gelaw Taye, Yewlsew Fentie, Tadese Tamire Department of Anesthesia, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Moges Gelaw TayeDepartment of Anesthesia, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, PO. Box: 272, EthiopiaEmail mgsglwty@gmail.comBackground: Problem-based learning is a student-centered innovative instructional approach in which students define their learning objectives by using triggers from the predefined problem case scenario. Problem-based learning is not about problem-solving; rather it uses appropriate problems to increase the problem-solving skills of students. This study aims to assess the medical and health science students’ perception towards problem-based learning method.Methods: An institution-based descriptive cross-sectional study was employed. All available graduating class Medical and Health Science students were included in this study.Results: More than half of the students (59.4%) strongly agree that problem-based learning was helpful to understand basic sciences knowledge and 31.5% of the students disagree that tutors are prepared and qualified to run the session. Some of the students (27.3%) disagree that tutors evaluate students fairly. About fifty-two percent of the students have used both books and Internets for self-directed learning.Conclusion: More than half of students agree that problem-based learning helped them understand basic science knowledge. Some of the students disagree that tutors are prepared and qualified to run the session, and disagree that tutors evaluate students fairly.Keywords: perception, medical and health science students, problem based learning

Metages Hunie, Efrem Fenta, Simegnew Kibret, Diriba Teshome Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Metages HunieDepartment of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, PO. Box 272, Debre Tabor, EthiopiaEmail huniemetages@gmail.comBackground: Spinal anesthesia block is the most widely practiced anesthesia technique due to its safety margin. It is an invasive procedure that could be associated with a variety of complications like total spinal, cardiovascular collapse, meningitis, paralysis, and even death. The aim of this study to assess the current practice of spinal anesthesia.Methods: A Cross-sectional study design was conducted in Debre Tabor Comprehensive Specialized Hospital from November 01 to December 15, 2020. All anesthesia professionals who are working in the study Hospital were surveyed by the Purposive sampling technique. A standardized structured checklist prepared from recommendations of New York school of regional anesthesia guideline regarding the current Practice of spinal anesthesia was used to collect the data after taking written informed consent. Descriptive statistics were employed to summarize the results.Results: A total of 24 anesthetists were observed of their practice before, during, and after administer of spinal anesthesia. All of the anesthetists were practicing the preparation and assembling of all necessary anesthesia equipments, resuscitation drugs, and basic monitors while all of the anesthetists did not wash their hands, wore a sterile gown, and draped the back of the patient with fenestrated drapes in a sterile fashion.Conclusion: Most of the anesthesiology professionals in our setting have a good preparation of all necessary anesthesia equipments, and resuscitation drugs, while the assessment of patient’s emotional reaction and pain during injection, the skin preparation allowed to being dry and assessment of the degree of sensory and motor block of the patient were insufficient.Keywords: spinal anesthesia, standards, Ethiopia

Background: The practice of antiemetic prophylaxis within the prevention and management of postoperative nausea and vomiting is important for optimal care of surgical patients. The poor practice of antiemetic prophylaxis on postoperative nausea and vomiting prevention come up with complications, reduce patient satisfaction, and increase overall costs. This study aims to assess practice and associated factors of antiemetic prophylaxis among health professionals in referral hospitals of Northwest Ethiopia. Method and materials: Institutional based cross-sectional study was conducted on 407 health professionals from February 27 to March 30, 2019, in referral Hospitals of Northwest Ethiopia. A stratified random sampling technique was used to select the study participants. A structured questionnaire was used to collect data. Bivariable and multivariable logistic regression was used to identify factors associated with the antiemetic prophylaxis practice level of health professionals on postoperative nausea and vomiting prevention and management. The p-values of < 0.05 were considered statistically significant. Results: In this study 153 (37.6%) of health professionals were practicing antiemetic prophylaxis. The multivariable logistic regression analysis showed that anesthetists were (AOR: 8.11; 95% CI: 3.27, 20.08) and physicians (AOR: 4.78; 95% CI: 2.46, 9.30) were more likely to give anti-emetic prophylaxis as compared with midwives. Learning in academic classes (AOR: 3.83; 95% CI: 1.46, 10.09), took training (AOR: 6.97; 95% CI: 2.208, 22.021), professionals who said that there are enough anti-emetic drugs available (AOR: 3.10; 95% CI: 1.67, 5.77), professionals, who respond that patients can afford to buy antiemetic’s (AOR: 3.56; 95% CI: 1.23, 10.32) were more likely to give anti-emetic prophylaxis as compared to their counterparts. Conclusions: Less than fifty percent (37.6%) of health Professionals practice antiemetic prophylaxis. Type of Profession, learning, training, availability, and cost of antiemetic drugs were factors significantly affecting the practice of antiemetic prophylaxis. Highlights: Less than fifty percent of health Professionals practice antiemetic prophylaxis. The availability, drugs affects the practice of antiemetic prophylaxis. The cost of anti-emetics affects the practice of antiemetic prophylaxis.

Background Post-dural puncture headache is a common complication after spinal anesthesia for women who undergo cesarean delivery. Intravenous (IV) dexamethasone has been used to reduce the incidence and severity of PDPH with controversial results. This Systemic review and meta-analysis aimed to assess the effects of IV dexamethasone on PDPH. Methods This study is reported as per Preferred Reporting Items for Systematic and Meta-analysis. The primary outcome was the incidence and severity of PDPH. The secondary outcome variables were the postoperative total analgesic requirement and incidence of nausea and/or vomiting. Twelve randomized controlled trials with a total of 1548 women were included. Results Intravenous (IV) dexamethasone had no effect on the incidence of PDPH (OR = 0.64; CI, 0.39 to 1.05; I2 = 71%, P = 0.08). Intravenous dexamethasone did not show a significant difference in the incidence of PDPH at 24 h at 48 h, and within one week postoperatively with p-values of less than 0.05. In a random-effect model, a pooled analysis showed that IV dexamethasone had no effect on the severity of PDPH in VAS (MD = 0.78; CI, −2.27 to 0.71; I2 = 98%, P = 0.30). Conclusion Intravenous dexamethasone failed to decrease the incidence and severity of PDPH in women who underwent cesarean delivery under spinal anesthesia., Highlights • PDPH is one of the unwanted complications of spinal anesthesia. • Intravenous dexamethasone failed to decrease the incidence of PDPH. • Intravenous dexamethasone failed to decrease the severity of PDPH. • Intravenous dexamethasone failed to decrease the analgesic consumption.

Purpose Emergency drugs and essential equipment are important to successfully manage patients in the intensive care unit (ICUs). The absence of these emergency drugs and essential equipment might result in mortality and morbidity which is more compounded in resource-limited settings. This study aims to assess the availability of emergency drugs and essential equipment in ICUs in hospitals in Ethiopia. Materials and methods A cross-sectional descriptive study design was employed in the intensive care unit of nine Amhara regional state hospitals in Ethiopia. This study was done from August 01, 2020, to September 01, 2020. The data were collected using a structured questionnaire, which were adopted from the Emergency Medicine Society of South Africa (EMSSA) guidelines. Tables and narration were used to describe results. Results There were deficiencies of essential emergency items particularly in the pediatrics domain, devices to confirm tracheal intubation and equipment for managing difficult intubation. Emergency drugs like adrenaline, salbutamol puff, atropine, aspirin, furosemide, hydrocortisone, insulin, lidocaine, and medical oxygen were available in all ICUs, whereas amiodarone, sodium bicarbonate, glucagon, ipratropium nebulization, thiamine were not available in all ICUs. Conclusions and recommendations There were considerable deficiencies in emergency drugs and essential equipment. Based on our findings, we recommend to develop standardized checklists, regular audits, and healthcare personnel awareness program to improve checking, maintaining, restocking, and repairing the equipment in the emergency trolley.

Informed consent is a process that needs time and effort to satisfy patients' desires. Patient dissatisfaction on preoperative informed consent process may be caused by multiple factors of clinical practice. This study aimed to assess patients' satisfaction and associated factors of informed consent process among elective surgical patients.A cross-sectional study was conducted on 404 postoperative patients who signed the informed consent for elective surgery. A systematic sampling technique was applied to select the study participants. Modified Leiden perioperative patient satisfaction tool was adapted to assess patients' satisfaction with preoperative informed consent process. Data were entered in to Epi-data version 4.20 and exported to SPSS version 20 for analysis. Bivariate and multivariable logistic regression was computed to identify independent variables associated with patient satisfaction towards preoperative informed consent process. A p-value of less than 0.05 was used to declare the statistical significance.The overall satisfaction of patients with preoperative informed consent process was 70.3%. Multivariable logistic regression analysis revealed that, being male (AOR: 4.75, 95% CI: 2.47-9.16), primary school (AOR: 8.42, 95% CI: 4.74-7.55), secondary school (AOR: 2.17, 95% CI: 5.74-8.62), rural residence (AOR: 1.8, 95% CI: 2.1-3.9) and received general anesthesia (AOR: 2.92, 95% CI: 1.62-5.26) were significantly associated with patients' satisfaction with the informed consent process.The overall patients' satisfaction on preoperative informed consent process was relatively low. Being male, low level of education, living in rural area, and receiving general anesthesia were significantly associated with patients' satisfaction on informed consent process. Surgeons and anesthesia professionals need to work more to improving the satisfaction of patients with preoperative informed consent process. Researchers are expected to do periodic assessment of patients' level of satisfaction and factors affecting satisfaction.

Background Fascia iliaca compartment nerve block is used for open reduction and internal fixation surgery of femoral fracture. Though dexamethasone is added to peripheral nerve block to increase analgesia efficacy but its effect on fascia iliaca is not known. Method A randomized control trial conducted in Hawassa University Comprehensive Specialized Hospital by recruiting 60 patients. Mann Whitney U test was used for distribution free data and independent t-test was used for normally distributed numeric data respectively. Categorical variable between two groups were analyzed using chi-square or fisher exact test. Data was expressed in terms of mean ± standard deviation for normally distributed data or median (inter quartile range) for skewed data. p -value Results There were statistically significant differences between the groups in time to first analgesia request p-value of = 0.003, tramadol, diclofenac and morphine consumption with p-value of, 0.017, 0.036 and 0.046 respectively. Regarding pain severity score a statistical significant differences were found at 6 and 12 h with p-values of 0.039 and 0.024 respectively while there was no statically significant difference in incidence of postoperative nausea vomiting (p = 0.448). Conclusion Administration of 8 mg intravenous dexamethasone to fascia iliaca compartment block increases time to first analgesic request, decrease total 24 h analgesic consumption. Trial registration number PACTR201910904223565.

Background Tracheal extubation, the purposeful removal of the endotracheal tube from the trachea, can be associated with detrimental hemodynamic and airway responses. Lidocaine and fentanyl are known to suppress hemodynamic responses to extubation during Ear, nose, and throat surgeries. Smooth tracheal extubation is important after Ear, nose, and throat surgeries. Objective To compare the effects of lidocaine versus fentanyl on attenuation of hemodynamic responses to extubation after ear, nose and throat surgery in a resource limited setting from January 01, 2018 to March 30, 2018. Methods This is a prospective cohort study recruits 74 American Society of Anesthesiologist class I and II, age between 18 and 60 patients who underwent Ear, Nose, and Throat surgeries. Unpaired T test was used to compare the mean heart rate and arterial blood pressure between lidocaine and fentanyl groups. Mann Whitney U Test was used for distribution free data. Association of categorical independent variables between two groups was analyzed using Chi Square or fisher exact test. P-values Results The demographic and clinical characteristics were comparable between groups. The pulse rate and mean arterial blood pressure were statistically significantly lower in fentanyl group at 1, 5, and 10 min after extubation with p values Conclusion The findings of our study demonstrate that fentanyl 1 μg/kg IV, administered 10 min before end of operation might be effective in attenuating hemodynamic response to tracheal extubation compared with lidocaine 1.5 mg/kg IV in patients underwent ENT surgeries.

Background Inadequate postoperative pain relief after Cesarean delivery has a negative impact on ambulation, breastfeeding, and maternal bonding. Transversus Abdominis Plane block and Wound Infiltration with local anesthetics are alternatives in reducing severity of pain, total analgesic consumption and opioid side effects. But their relative analgesic effectiveness is not well established. Objective To compare analgesic effectiveness of Transversus Abdominis Plane block (TAP) versus Wound site Infiltration (WI) after cesarean delivery under spinal anesthesia. Methods Hospital based prospective cohort study was conducted at Debre Tabor General Hospital in Sixty-two parturites scheduled for elective cesarean section under spinal anesthesia. Chi square or fisher exact test was used for discrete variables and Manny Whitney test was used for comparing numerical variables of skewed data or student's t-test was used for comparing numerical variables normally distributed data of two groups. P-value less than 0.05 was considered as statistically significant. Result Our study showed that when TAP block compared with WI after cesarean delivery reduces postoperative tramadol and diclofenac consumption, increase time to first analgesic request time, and reduces pain severity score at 6th, 12th, and 24th hours were found to be statistically significant between the groups (p 0.05). Conclusion TAP block might be better to WI for post-operative pain management in mothers who have had cesarean delivery and it provided longer lasting and more efficient analgesia.

Background Poorly managed postoperative pain may delay discharge and recovery, lowers the quality of life, and it may result in chronic pain. Intravenous (IV) dexamethasone has been used as an additive to local anesthetic for peripheral nerve blocks (PNBs) with variable efficacy. The aim of this Systemic review and meta-analysis is to assess the effectiveness of IV dexamethasone as an adjuvant to local anesthetic for PNBs. Methods The PRISMA statement guideline is followed to conduct this SR and MA. The primary outcome was the duration of analgesia analyzed according to a dose of dexamethasone (4, 8, and 10 mg). Secondary outcomes included duration of sensory block, duration of motor block, postoperative opioid consumption, pain severity score, patient satisfaction, and incidence of PONV. Eleven randomized controlled trials, including 709 patients, were included. Results The duration of analgesia was significantly prolonged with IV dexamethasone with a mean difference of 5.04 h CI, 2.65 to 7.44; I2 = 100%, P Conclusions IV dexamethasone as an additive to PNBs could increase duration analgesia, sensory block and decreases postoperative pain severity, opioids consumption, and sleep disturbance of first night after surgery.

Background Anesthesia and analgesia for surgeries to the upper extremity are commonly provided using the brachial plexus block. Tramadol and fentanyl are used to fasten the onset and prolong the duration of the axillary brachial plexus block, but their relative efficacy is not well established. Methodology The study was conducted on 63 patients who underwent hand, wrist and forearm surgeries. Patients were randomly allocated in to three groups. Group T (n = 21) received 100 mg tramadol + 0.25% bupivacaine, group F (n = 21) received 50 μg fentanyl + 0.25% bupivacaine and group B (n = 21) received 0.25% bupivacaine. Parametric data and non-parametric data was analyzed by ANOVA and Kruskal-Wallis H tests respectively. Chi-square test was used to assess the association of dependent and independent variables of categorical data. P-values less than 0.05 were considered as statistically significant. Result There was no statistically significant difference regarding demographic variables. Time onset of sensory and motor block was shorter in group F than group T and group B (p Conclusion Addition of tramadol or fentanyl to bupivacaine in axillary block fastens the onset and prolongs its duration. Tramadol is superior to fentanyl in terms of duration. Trial registration number PACTR202001635673534.

Background Identifying the factors associated with post-operative sore throat is important for better patient outcome. Supportive evidence towards it is not well-established in developing countries like Ethiopia. Objective To assess the incidence and factors associated with postoperative sore throat among patients undergoing elective surgery under general anesthesia with endotracheal intubation. Methods Hospital based cross-sectional study design was employed. Binary and multivariable logistic regression were used to measure association between the factors and the outcome at 95%CI using Adjusted Odds ratio (AOR). P-value Results A total of 123 patients were included in this study and the incidence of postoperative sore throat within 24 h after operation was 48.8%. In multivariate logistic regression, being female (AOR = 2.57, 95% CI: 1.13, 5.85) and multiple number of attempts (AOR = 3.81, 95% CI: 1.51, 9.62) had significant association with post-operative sorethroat. The ETT sizes of 6.5, 7.0 and 7.5 in millimeter were the factors statistically significantly associated with post-operative sore throat with p values of 0.01, 0.02 and 0.03 respectively. Conclusions Larger ETT size and multiple number of attempts of laryngoscopy might increase the risk of developing postoperative sore throat.

Sleep quality refers to a sense of being refreshed and rested after waking up from sleep. Postoperative patients were vulnerable to poor sleep quality due to having different contributing factors. The prevalence of poor sleep quality among postsurgical patients was left undisclosed in our study setting. Knowing the prevalence and contributing factors for poor sleep quality helps us to develop a strategic plan for prevention and management.A multicenter cross-sectional study design was conducted on 424 postsurgical patients who were selected by a systematic random sampling method. Data was collected using the Pittsburgh Sleep Quality Index by a face-to-face interview. Data analysis was done using SPSS version 25. For categorical data, a chi-square test was done. Bivariable and multivariable analyses were performed to determine whether each of the independent variables is associated with the outcome variable.Based on this study result, the prevalence of poor sleep quality was 64.9%. Among the factors included in this study, variables which had an association with poor postoperative sleep quality were age range 25-54 years (AOR = 15.13), male gender (AOR = 4.81), educational level of secondary school (AOR = 6.29), patient income less than 2500 birr (AOR = 3.77), anxiety (AOR = 2.53), depression(AOR = 22.8), light exposure(AOR = 19.60), poor social support (AOR = 1.98), being emergency surgery (AOR = 2.46) and having a history of moderate to severe pain (AOR = 38.18, (95% CI).Poor sleep quality among adult post-surgical patients was significantly high in Amhara regional comprehensive referral hospitals. Therefore; Clinicians need to prioritize postoperative sleep quality assessment and needs to minimize factors inducing postoperative sleep disturbances.

Background: Early postoperative hypoxemia is a common problem after general anesthesia. The identification of factors associated with an increased occurrence of it might help healthcare professionals to hypoxemia risk patients, therefore this study aims to assess the incidence and factors associated with early postoperative hypoxemia among surgical procedures.Methods: A prospective cohort study design was conducted from February 1, 2020 to June 30, 2020, on a total of 424 patients who underwent surgery under general anesthesia in Debre Tabor Comprehensive Specialized Hospital. The data was collected using a structured checklist. Bivariable and multivariable logistic regressions were used to check the association.Results: The incidence of early postoperative hypoxemia was 45.8%. Patients having a BMI of 25-29.9 kg/m2 and BMI of 30-39.9 kg/m2, patients having a chronic disease, current smokers, SPO2 reading before induction of less than 95%, emergency surgery, and the absence of oxygen therapy during the period of transfer and/or in the post anesthesia care unit were significantly associated with an increased risk of hypoxemia in the early postoperative period.Conclusions: The incidence of early postoperative hypoxemia was high in Debre Tabor Comprehensive Specialized Hospital. Obese patients, patients having a chronic disease, current smokers, and lower oxygen saturations before induction, emergency surgery, and the absence of oxygen therapy were the main predictors of an increased occurrence of early postoperative hypoxemia

Background Pulmonary aspiration is one of the most important complications of obstetric anesthesia. Prevention of pulmonary aspiration is commonly performed by the application of different anesthetic maneuvers and administration of drugs. This study aimed to assess the non-physician anesthetic providers current practice of aspiration prophylaxis during anesthesia for cesarean section in Ethiopia. Methods This survey study was conducted from October 01 to November 05, 2020, on a total of 490 anesthetic providers working in hospitals in Ethiopia. A structured checklist was used to collect data from non-physician anesthetic providers. Results Four hundred and ninety (490) anesthetic providers participated in our study. The majority of the respondents (84%) were working in the public sector. Most of the cesarean delivery was done under regional anesthesia and more than half of anesthetic providers in Ethiopia administered aspiration prophylaxis routinely. Metoclopramide was the most frequently given as a prophylaxis for pulmonary aspiration. Conclusions More than half of the anesthetic providers administered aspiration prophylaxis routinely. Metoclopramide was the commonest administered aspiration prophylaxis for parturients who underwent cesarean delivery to prevent aspiration.

Background Early intraoperative hypotension (eIOH) is a common complication of general anesthesia and is significantly associated with postoperative morbidity and mortality. The incidence of eIOH was high, especially in resource-limited settings. Identifying the factors associated with the occurrence of eIOH might allow avoidance and planning of a timely treatment of it. Objective To assess the incidence of early intraoperative hypotension and its associated factors among surgical patients undergoing Surgical procedures under general anesthesia at XX Comprehensive Specialized Hospital, North-central Ethiopia, 2021. Methods A total of 424 surgical patients under general anesthesia were included in this prospective observational study. The data were collected by a structured questionnaire. Variables with p-values of less than 0.2 in the bivariable logistic regression were fitted to multivariable logistic regression. Data was presented in odds ratios with a 95% confidence interval. Descriptive statistics were used to summarize data. Results The incidence of early intra-operative hypotension (eIOH) was 21.2%. In this study older age (age≥ 60 years) (AOR: 2.063 (95% CI;1.194, 3.563)), ASA physical status (AOR: (II2.259 (95% CI;1.229, 4.153)), III(AOR: 2.810 (95% CI;1.319, 5.986)), a BMI of 25–29.9 kg/m2 (AOR: 2.098 (1.128, 3.901), a BMI of ≥30 kg/m2 (AOR: 3.090 (95% CI;1.324, 7.210)), emergency surgical procedures (AOR: 2.215 (95% CI;1.287, 3.810)), the estimated blood loss greater than 500 ml (AOR: 2.510 (95% CI;1.478, 4.261)) were found to be independent factors of eIOH. Conclusion This study revealed that the incidence of eIOH was high (21.2%). Older age, ASA II and III, BMI ≥25, emergency surgical procedures, and a significant amount of blood loss (EBL ≥500 ml) were the main predictors of an increased occurrence of eIOH., Highlights • Early intraoperative hypotension is associated with postoperative morbidity and mortality. • Emergency surgical procedures, and a significant amount of blood loss are the main predictors of an increased occurrence of eIOH. • Thyroidectomy has a relatively short duration and less amount of estimated blood loss when compared to major surgical procedures. • The occurrence of eIOH after general anesthesia for general surgery is a common problem. • Arterial hypotension in patients undergoing surgery under general anesthesia usually described by the very general term intraoperative hypotension.

Aragaw Tesfaw,1 Mekdim Eshetu,2 Fentaw Teshome,1 Efrem Fenta,3 Moges Gelaw,3 Gashaw Mihret,2 Getaneh Atiklt,1 Tewodros Yosef4 1Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia; 2School of Medicine, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia; 3Department of Anaesthesia, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia; 4School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, EthiopiaCorrespondence: Aragaw TesfawDepartment of Public Health, College of Health Science, Debre Tabor University, P.O. Box: 272, Debre Tabor, EthiopiaTel +251 921743820Email aragetesfa05@gmail.comBackground: Head injury is one of the most common reasons for patient admission and death in surgical units of Ethiopian hospitals, but little is known about the problem in North-central Ethiopia. Therefore, this study aimed to assess the magnitude and associated factors of head injury at Debre Tabor Teaching and Referral Hospital in south Gondar zone, North-central Ethiopia.Methods: A cross-sectional study was conducted on 370 trauma patients at Debre Tabor Teaching and Referral Hospital from November 1 to December 30, 2019, using a systematic random sampling technique. The data were collected through a face-to-face interview. The data were analyzed using SPSS version 23. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with head injury. P-value < 0.05 was used to declare statistical significance.Results: The mean (±SD) age of patients was 41.4 (± 11.6) years. The prevalence of head injury was 39.7%, 95% CI (34.9– 44.9%). Two hundred sixty-five (72%) were male and 259 (70%) of all trauma patients were from rural residents. The study also found that younger age (20– 24 years) [AOR=1.2; 95% CI (1.29– 8.86)], being male [(AOR=2.02; 95% CI (1.31– 6.24)], alcohol use [(AOR=6.31; 95% CI (2.03– 16.08)], and rural residence [(AOR= 1.40; 95% CI (1.13– 6.94)] were the factors associated with head injury.Conclusion: Like other studies done in Ethiopia, head injury is a major problem in the study area. The study also revealed that socio-demographic and behavioral factors are mainly associated with head injury. Therefore, appropriate prevention strategies should be devised and implemented against the contributing factors both at the individual and community level to minimize the risk of head injury.Keywords: head injury, prevalence, trauma, Ethiopia

Background Midline laparotomy is associated with severe postoperative pain. Literature showed controversial results regarding the efficacy of the rectus sheath block. Methods This is a prospective cohort study that recruits 30 patients in the rectus sheath block (RSB) group and 30 patients in the multimodal analgesia (MMA) group who underwent emergency midline laparotomy. The RSB was performed by an experienced anesthetist using a land-mark technique. Independent t-test and Mann-Whitney-U test were used for numeric data while Chi-Square or Fisher exact test was used for categorical variables. P-values < 0.05 were considered as statistically significant. Results The numeric rating scale score at the recovery was significantly reduced in an RSB group with a p-value of 0.039. Postoperative numeric rating scale scores at 3rd, 6th, 12th, and 24th hours were statistically significantly lower in the RSB group. Postoperative tramadol consumption in 24 h was significantly lower with a p-value of 0.0001 for the rectus sheath group. Conclusions For midline laparotomy, adding a bilateral rectus sheath block at the end of the operation might be an effective postoperative analgesia option., Highlights • BRSB might reduce a postoperative pain severity score. • Postoperative analgesic consumption might be reduced in BRSB group. • BRSB could decrease the incidence of postoperative Nausea and vomiting.

Introduction Caesarean section is one of the lifesaving procedures of medical interventions attributed to the decrease of maternal and newborn mortality and morbidity rates. The World Health Organization (WHO) shows a cesarean rate between 5% and 15%. However, the prevalence of cesarean section is increasing globally as well as in Ethiopia. Different scholars argue that the prevalence and factors of the caesarian section vary in different countries and health institutions. The aim of this study was to assess the prevalence and factors associated with cesarean section in Debre Tabor Comprehensive Specialized Hospital. Method An institutional-based cross-sectional study was conducted on a total of 320 mothers who gave birth at Debre Tabor Comprehensive Specialized Hospital from July 01, 2020, to October 30, 2020. The samples were selected using the convenience sampling technique. The Data were collected using a structured checklist. Bivariable and multivariable logistic regressions were used to check the association. P-values less than 0.05 were considered statistically significant. Results The overall prevalence of cesarean section was 39.1% in the current study. Mothers age 35–39 years, educational level college and above, employed, mothers with a monthly income of >6000, and mothers with a previous history of cesarean section were significantly associated with an increased risk of cesarean section. Conclusion The prevalence of cesarean section was high in Debre Tabor Comprehensive Specialized Hospital. Age of the mothers, educational status, occupation, monthly income, and previous history of cesarean section were significantly associated with an increased occurrence of cesarean section., Highlights • C/S rate is high in Debre Tabor Comprehensive Specialized Hospital • Level of education and monthly income influence the rate of C/S • Number of ANC follow up does not affect C/S rate

Background. Substances mainly khat, alcohol and cigarette are used during pregnancy in Ethiopia. However, to this date, there is no pooled evidence about the burden of adverse neonatal outcomes among the substance users during pregnancy in the country. Methods. Eligible primary studies were accessed from 4 international data bases (Google Scholar, Science Direct, Scopus, and PubMed). The required data were extracted from these studies and then exported to stata version 14 for analysis. Subgroup analyses were conducted for evidence of heterogeneity. Results. A total of 2298 neonates were included from 7 studies. Among these neonates, 530(23.06%) were those whose mothers used substance during pregnancy (exposed group) whereas 1768 neonates were those whose mothers didn’t use substance during pregnancy (controls group). The pooled prevalence of adverse neonatal outcome among the exposed mothers was 38.32% (95% CI: 29.48%, 47.16%; I2 = 76.3%) whereas it was 16.29% (95% CI: 9.45%, 23.13%) among the controls. Adverse neonatal outcome was most burdensome among cigarette smokers 45.20% (95% CI: 37.68%, 52.73%; I2 = .00%) when compared with khat chewers 34.00% (95% CI: 20.87%, 47.13%) and alcohol drinkers 38.47% (95% CI: 17.96%, 58.98%). Low birth weight 42.00% (95% CI: 18.01%, 65.99%; I2 = 91.8%) was the most common adverse birth outcome. Conclusion. It was found that adverse neonatal outcomes were much more burdensome among antenatal substance users than the controls. Therefore, mothers should be enabled to quit using substance before pregnancy. Besides, strict comprehensive screening of every pregnant mother should be made at antenatal care clinics for early identification and management of antenatal substance use.

Patient satisfaction with perioperative anesthesia services is not well established in developing countries like Ethiopia. This study aimed to assess surgical patients' satisfaction with perioperative anesthesia service and its associated factors.A cross-sectional study design was conducted in patients who underwent surgeries at Debre Tabor Comprehensive Specialized Hospital, in North Central Ethiopia. Data were collected by Leiden perioperative care patient satisfaction questionnaire (LPPSq) within 24 h postoperatively, after translating to the local language (Amharic). Bivariable and multivariable logistic analyses were done to identify factors associated with satisfaction with perioperative anesthesia service care. Statistical significance level was set at P0.05 with 95% CI.Analysis was done on 387 patients with a response rate of 94.8%. The overall mean satisfaction of patients with perioperative anesthesia care was 62.62% and about 53.7% [95% CI= (48.6-58.4)] of patients were satisfied with perioperative anesthesia service. The mean satisfaction of perioperative anesthesia service in the patient-staff relationship domain was 61.44%; in the information provision domain was 60.32%, and in the fear and concern domain was 72.06%.There was a moderate level of satisfaction in patients with perioperative anesthesia service. Among the subscales of LPPSq, the lowest satisfaction score was in the information provision and the highest satisfaction score was in the fear and concern domain.

Background Despite the higher mortality rate of breast cancer in low and middle-income countries, the practice of early detection methods is low and the majority of the patients presenting at an advanced stage of the disease need palliative care with low survival rates. Although healthcare providers are the key for practicing early detection methods of breast cancer for themselves and their clients, little is known about their knowledge and practice of early detection methods of breast cancer in Northcentral Ethiopia. Methods An institution-based cross-sectional study was conducted among female healthcare providers at Debre Tabor Comprehensive Specialised Hospital. Data were collected using a structured self-administered questionnaire. The data were analysed using SPSS version 23. Descriptive statistics were used to describe the socio-demographic information of participants. Binary and multivariable logistic regression with adjusted odds ratio (AOR) and 95% confidence interval (CI) was used to identify factors associated with the outcome variable. Statistical significance was declared at p Result The mean (±SD) age of the participants was 31.4 (±7.8) years. About 106 (79.7%) participants had good knowledge about breast cancer early detection methods and only 56 (42.1%) of them practiced breast self-examination regularly. Work experience of >2 years (AOR = 3.2; 95% CI: 1.72, 5.29), history of any breast problem (AOR = 1.4; 95% CI: 1.02, 2.37), family history of breast cancer (AOR = 4.0; 95% CI: 2.58, 15.84), having good knowledge (AOR = 2.9; 95% CI: 1.3, 6.52) and history of comorbidities (AOR = 1.09; 95% CI: 1.09, 3.59) were the factors associated with the practice of breast self-examination. Conclusion Our study found that the knowledge and practice of breast cancer early detection methods was low in the study setting. Only less than half of female healthcare providers practiced regular breast self-examination, which suggests the need to provide training for healthcare providers to fill the gap and to promote early detection of breast cancer cases.

Metages Hunie,1 Tiruwork Desse,2 Diriba Teshome,1 Simegnew Kibret,1 Moges Gelaw,1 Efrem Fenta1 1Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 2Department of Internal Medicine, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Metages Hunie Email huniemetages@gmail.comBackground: The application of cricoid pressure requires good knowledge and practice of health professionals who are working in operation theatres to prevent pulmonary aspiration. This study aims to assess the application of cricoid pressure knowledge and practice in health professionals who are working in the operation theatres.Methods: This survey-based study was conducted in health care professionals who are working in the operation theatre of Debre Tabor Comprehensive Specialized Hospital from November 1 to December 1, 2020. A structured checklist was used to collect data regarding the knowledge and practice of the application of cricoid pressure.Results: A total of 43 health professionals who are working in the operation theaters were involved in this study with a response rate of 81%. The correct anatomic position of cricoid cartilage was not identified in 67% of nurses. We found that 78% of anesthetists did not use the nasogastric tube for decompression, and 83% of them complain of difficult intubation during the application of cricoid pressure.Conclusion: Health care professionals who are working in operation theatres had poor knowledge and practice in the application of cricoid pressure.Keywords: knowledge, practice, health professionals, cricoid pressure

Supplemental material, sj-pdf-2-gph-10.1177_2333794X211019699 for The Burden of Adverse Neonatal Outcome among Antenatal Substance Users in Ethiopia: A Systematic Review and Meta-Analysis by Wubet Alebachew Bayih, Metadel Yibeltal Ayalew, Melaku Tadege, Maru Mekie, Teklehaimanot Kiros, Eshetie Molla Alemu, Efrem Fenta Alemnew, Lemma Getacher, Demeke Mesfin Belay, Binyam Minuye Birhane, Dr Kassaw Demilie Alemu, Getachew Yideg Yitbarek and Belayneh Kefale in Global Pediatric Health

Supplemental material, sj-pdf-3-gph-10.1177_2333794X211019699 for The Burden of Adverse Neonatal Outcome among Antenatal Substance Users in Ethiopia: A Systematic Review and Meta-Analysis by Wubet Alebachew Bayih, Metadel Yibeltal Ayalew, Melaku Tadege, Maru Mekie, Teklehaimanot Kiros, Eshetie Molla Alemu, Efrem Fenta Alemnew, Lemma Getacher, Demeke Mesfin Belay, Binyam Minuye Birhane, Dr Kassaw Demilie Alemu, Getachew Yideg Yitbarek and Belayneh Kefale in Global Pediatric Health

Supplemental material, sj-pdf-4-gph-10.1177_2333794X211019699 for The Burden of Adverse Neonatal Outcome among Antenatal Substance Users in Ethiopia: A Systematic Review and Meta-Analysis by Wubet Alebachew Bayih, Metadel Yibeltal Ayalew, Melaku Tadege, Maru Mekie, Teklehaimanot Kiros, Eshetie Molla Alemu, Efrem Fenta Alemnew, Lemma Getacher, Demeke Mesfin Belay, Binyam Minuye Birhane, Dr Kassaw Demilie Alemu, Getachew Yideg Yitbarek and Belayneh Kefale in Global Pediatric Health

Supplemental material, sj-pdf-1-gph-10.1177_2333794X211019699 for The Burden of Adverse Neonatal Outcome among Antenatal Substance Users in Ethiopia: A Systematic Review and Meta-Analysis by Wubet Alebachew Bayih, Metadel Yibeltal Ayalew, Melaku Tadege, Maru Mekie, Teklehaimanot Kiros, Eshetie Molla Alemu, Efrem Fenta Alemnew, Lemma Getacher, Demeke Mesfin Belay, Binyam Minuye Birhane, Dr Kassaw Demilie Alemu, Getachew Yideg Yitbarek and Belayneh Kefale in Global Pediatric Health

Background Midline laparotomy is associated with severe postoperative pain. Literature showed controversial results regarding the efficacy of the rectus sheath block. Objective To assess the effectiveness of rectus sheath block efficacy for patients who underwent emergency midline laparotomy at a resource limited setting in Northcentral Ethiopia, from February 01 to March 30, 2019. Methods This is a prospective cohort study that recruits 60 patients who underwent emergency midline laparotomy. Independent t-test and Manny Whitney tests were used for numeric data while Chi-Square or Fisher exact test was used for categorical variables. P-values < 0.05 were considered as statistically significant. Results The median (interquartile range) of the numeric rating scale score at the recovery was 3(3-4) for an exposed group and 4.5(3-4.5) for an unexposed group with a p-value of 0.039. Postoperative numeric rating scale scores at 3 rd , 6 th , 12 th , and 24 th hours were statistically significantly lower in the exposed group. Postoperative tramadol consumption in 24 hours was significantly lower with a p-value of 0.0001 for the rectus sheath group. Conclusions For surgeries done through midline laparotomy, adding bilateral rectus sheath block (BRSB) at the end of the operation might be an effective postoperative analgesia option.