Search

Abstract Introduction Understanding the extent to which faculty members' beliefs, attitudes, and acceptance of educational technologies for learning is crucial for enhancing the effectiveness of technology and ensuring its long-term viability. However, higher education institutions have made significant investments in educational technology for learning without fully comprehending faculty members' beliefs, attitudes, and level of acceptance of these technologies. This lack of understanding has hindered the effectiveness of these investments. Therefore, this study aims to examine faculty members' beliefs, attitudes and level of acceptance towards educational technology in higher education institutions in Ethiopia. Methods A survey was conducted at five public higher education institutions that offer priority health training programs. The survey collected data using the Unified Theory of Acceptance and Use of Technology, focusing on four key determinants. Faculty members were asked to rate these determinants on a scale of 1 to 5. Each determinant was analyzed separately, examining the mean value and standard deviation. An overall mean score was calculated by combining all the determinants. Additionally, a logistic regression analysis was performed to determine how different demographic factors influenced faculty members' acceptance of technology for student learning. Result A total of 330 faculty members participated in the study. The majority of respondents were male lecturers who held a second degree qualification. On average, the participants were 32.9 years old and had six years of teaching experience. Interestingly, nearly three fourth (72.6%) of faculty members hold positive beliefs and exhibit a high level of acceptance of educational technology. Furthermore, the likelihood of accepting and utilizing technologies for learning was found to be 2.3 times higher for faculty members working in teaching settings at research institutions. Conclusion Faculty members have a favorable attitude towards educational technology, demonstrating a high level of acceptance. This positive belief holds significant implications and is crucial for enhancing the effectiveness of technology and ensuring its long-term viability.

BackgroundAcute postoperative pain after thoracic surgery might lead to chronic postsurgical pain (PSP), which lowers quality of life. The literature suggests thoracic paravertebral block (PVB) as a pain management approach. The ESPB (erector spinae plane block) is regarded to be an effective PVB alternative. The analgesic efficacy of the two analgesic therapies is controversial. The purpose of this study is to compare the analgesic efficacy of ESPB and PVB in preventing acute PSP.MethodsWe searched relevant articles in PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar databases. The primary outcome was postoperative pain score, with secondary outcomes including analgesic consumption, the frequency of rescue analgesia, and postoperative nausea and vomiting.ResultsThis meta-analysis included ten RCTs with a total of 670 patients. PVB significantly lowered the pain scores at movement at 12 h following surgery as compared to the ESPB. The PVB group used much less opioids within 24 h after surgery compared to the ESPB group. However, there were no significant differences between the groups in terms of postoperative rescue analgesia or in the incidence of postoperative nausea and vomiting (p > 0.05).ConclusionPVB produced superior analgesia than ESPB in patients who underwent thoracic surgeries. In addition, PVB demonstrated greater opioid sparing effect by consuming much less opioids.Systematic review registrationThis trial is registered on PROSPERO, number CRD42023412159.

BackgroundAdequate children’s pain management is universally considered an ethical obligation. In evaluating and treating children’s pain, nurses invest more time and take a leading role. This study aims to evaluate the knowledge and attitudes of nurses towards the treatment of pediatric pain.Materials and MethodsA total of 292 nurses working at four South Gondar Zone hospitals of Ethiopia was surveyed. To gather information from study participants, the Pediatric Nurses’ -Knowledge and Attitudes- Survey Regarding Pain (PNKAS) was employed. Frequency, percentage, mean, and standard deviation of the data were used for descriptive analysis, while Pearson correlation, one-way between-groups analysis of variance, and independent-samples t-test were used for inferential analysis.ResultsA large percentage of nurses (74.7%) lacked adequate knowledge and attitudes (PNKAS score

Abstract Background Excellence in Anesthesia education has been advocated to meet the current and future needs of the society. Educational environment plays significant role in determining students’ learning and academic achievement. This study assessed the perception of Anesthesia students on their educational environment and it association with their academic achievement at Debre Tabor University and University of Gondar. Methods A comparative cross-sectional study design was employed on 3rd and 4th year students. Dundee Ready Educational Environment Measure (DREEM) was used to assess students’ perception on their educational environment. Perceived performance, Cumulative Grade Point Average (CGPA) and 100 MCQ items were used to assess the academic achievement of the students. An independent t-test was used to assess the differences in the perception of educational environment and academic achievements. Bivariate and multivariable linear regressions were fitted to assess the relationship between perception on educational environment and academic achievement. A P-value of less than 0.05 was used to declare the statistical significance. Result A total of 123 students (91 from University of Gondar and 32 from Debre Tabor University) were participated on this study. The study showed no statistically significant differences between the groups on the perception of students on the educational environment on DREEM total and subscale scores, and academic achievements. However, there were statistically significant differences in some items of the educational environment measures. On multivariable linear regression; entrance exam result, students’ perception of teachers, students’ academic self –perception and students’ social self-perception showed positive correlation with students’ academic achievement (ß = 0.003 & P = 0.04, ß = 0.009 & P = 0.9, ß = 0.06 & P = 0.42, ß = 0.06 & P = 0.39, ß = 0.14 & P = 0.015 and ß = 0.13 & P = 0.023) respectively. Conclusion The perception of students on the educational environment was found to be more positive and there was no statistically significant differences in total and domains of DREEM scores and academic achievement of students between the two institutions. Entrance exam result and more positive perception of the educational environment were positively associated with academic achievement of students.

BackgroundShivering is a common complication after subarachnoid administration of local anesthetics. Intravenous ketamine and tramadol are widely available anti-shivering drugs, especially in developing settings. This meta-analysis aimed to compare the effects of intravenous ketamine vs. tramadol for post-spinal anesthesia shivering.Materials and methodsPubMed/MEDLINE, Web of Science, Cochrane Library, Embase, and Google Scholar databases were used to search for relevant articles for this study. Mean difference (MD) with 95% confidence interval (CI) was used to analyze continuous outcomes, and risk ratio (RR) with 95% CI to analyze categorical results. The heterogeneity of the included studies was assessed using the I2 test. We utilized Review Manager 5.4.1 to perform statistical analysis.ResultsThirteen studies involving 1,532 patients were included in this meta-analysis. Ketamine had comparable effects in preventing post-spinal anesthetics shivering [RR = 1.06; 95% CI (0.94, 1.20), P = 0.33, I2 = 77], and onset of shivering [MD = −0.10; 95%CI (– 2.68, 2.48), P = 0.94, I2 = 0%], lower incidences of nausea and vomiting [RR = 0.51; 95%CI (0.26, 0.99), P = 0.05, I2 = 67%], and lower incidences of bradycardia [RR = 0.16; 95%CI (0.05, 0.47), P = 0.001, I2 = 33%], higher incidence of hallucinations [RR = 12; 95%CI (1.58, 91.40), P = 0.02, I2 = 0%], and comparable effects regarding the incidences of hypotension [RR = 0.60; 95%CI (0.30, 1.21), P = 0.15, I2 = 54%] as compared to tramadol.ConclusionsIntravenous ketamine and tramadol are comparable in the prevention of post-spinal anesthetic shivering. Ketamine had a better outcome with less occurrences of nausea, vomiting, and bradycardia. However, ketamine was associated with higher incidences of hallucinations than tramadol.

IntroductionExcellence in anesthesia education has been advocated to meet the current and future needs of society. Universities play a key role in creating a conducive climate for learning and facilitating the development of expected competencies among graduates. This study assessed students’ learning approaches and their relationship with their academic achievement at two selected public universities in Ethiopia.Materials and methodsA cross-sectional study was conducted on 123 anesthesia students. All 3rd- and 4th-year students were recruited for the study. Study Skills Inventory for Students (ASSIST) was used to assess students’ learning approaches. Perceived performance, cumulative grade point average (cGPA), and 100 MCQ items were used to assess academic achievement. Data were entered into Epi-data and exported to SPSS for statistical analysis. An independent t-test was used to determine the presence of a difference in academic achievement across learning approaches. Bivariate and multivariable linear regressions were fitted to assess the association of students’ characteristics and learning approaches with their academic achievement. A P-value of less than 0.05 was used to declare the statistical significance.ResultThere were no statistically significant differences between the groups on most of the learning approaches and academic achievement measures. In multivariable linear regression, university entrance exam results, students’ perception of the definition of learning, and a deep approach to learning were found to be the predictors of students’ academic achievement (β = 0.004 and P = 0.03, β = 0.14 and P = 0.015, and β = 0.13 and P = 0.023), respectively.ConclusionIn this study, students mainly follow deep approaches to learning, and there were no statistically significant differences between the groups on most of the learning approach measures and academic achievements. Entrance exam results, positive perception of the definition of learning, and a deep approach to learning were found to be positive predictors of academic achievement. Emphasis has to be given to improving students’ learning approaches for better academic achievement and success.

Background: 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. Method: 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 P < 0.05 with 95% CI. Results: 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%. Conclusion: 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.

Objective of the studyThe objective of this study was to identify determinants of syphilis infection among pregnant women attending antenatal care in hospitals in the Wolaita zone, Southern Ethiopia,2020.MethodsAn unmatched facility-based case-control study was conducted among pregnant women who received antenatal care at four randomly selected hospitals from September 1 to October 30, 2020. A two-stage sampling technique was used in the selection of hospitals and study participants. The data were collected from the participants using a pre-tested structured questionnaire and analyzed using STATA Release 15. Bivariate and multivariate logistic regression analyses were used to determine syphilis infection determinants. Crude and adjusted odds ratios were used for each explanatory variable with a 95% confidence level. A statistically significant association was declared when a p-value was less than 0.05.ResultsA total of 296 (74 cases and 222 controls) pregnant women participated, with a recruitment rate of 97.4%. In multivariate logistic regression, the likelihood of developing a maternal syphilis infection was higher in pregnant women who had more than one-lifetime sexual partner [AOR = 3.59, 95% CI (1.09-11.71)]; a history of sexually transmitted infections [AOR = 3.46, 95%CI (1.32-9.08)] and used a substance [AOR = 3.39, 95%CI (1.31-8.77)].ConclusionSexual-related factors continued to be a major determinant of syphilis in pregnant women. The results suggest that there is a need to promote safe sexual behavior, raise awareness about the risk of STIs, and early diagnosis and treatment of STIs to control syphilis infection, and necessary to make the antenatal care service comprehensive for pregnant women.

Objectives: Post-operative pain is a form of acute pain following surgical intervention. And it is due to skin incision, tissue dissection, manipulation, and traction during the surgical procedure. The magnitude may reach up to 85.5% globally. Age, gender, duration of surgery, and length of skin incision were the common factors for post-operative pain. This study aims to assess the magnitude and associated factors of post-operative pain among surgical patients. Methods: Institutional-based cross-sectional study design was used. The study was conducted on a total of 159 surgical patients aged 8 years and above. The data were collected using chart review and recording the status of post-operative pain by the result of the Numeric Rating Scale at 1, 6, 12, 24, and 72 h of the post-operative period. Descriptive statistics, bivariate, and multivariable logistic regression were used. An adjusted odds ratio with a 95% confidence interval was used to determine the association. A p -value of less than 0.05 was used to declare statistical significance. Results: The majority (58.5%) of the study participants were females. The percentage of moderate to severe post-operative pain (Numeric Rating Scale: 4 and above) was between 37.7% within 1 h and 76.7% at 6 h of post-operative period. On multivariable logistic regression being female gender, preoperative pain and large skin incision were significantly associated with post-operative pain. Conclusions: Post-operative pain is still high which needs the attention of health professionals working on surgical patients and considering factors associated with post-operative pain.

Background: Misconception about epilepsy in Ethiopia is higher which in turn affects overall quality of life of the individuals. This research was aimed to assess knowledge and attitude of the community towards epilepsy in Northwest Ethiopia. Methods: A community-based cross-sectional study was conducted. Data was entered by Epi data version 4.2 and analyzed by SPSS version 24. Descriptive and analytical statistical procedures, with 95% confidence interval were employed and significance level was determined at p-value

BackgroundThe World Health Organization declared the outbreak of COVID-19 as a pandemic on 11 March 2020. Healthcare workers are directly involved in the prevention, diagnosis, treatment, and care of patients with COVID-19.This study aims to assess the prevalence of anxiety and its associated factors towards the COVID-19 outbreak among healthcare workers in a Hospital of Ethiopia.MethodsA Hospital-based survey study was conducted on a total of 305 Healthcare workers in a Hospital of Ethiopia. Bivariable and multivariable logistic regression were used to analyze data between independent variables with anxiety. Variables with a p-value of ResultsThe prevalence of CVID-19 anxiety was 63%. In multivariate logistic regression, age of 30-39 (AOR, 3.05; 95% CI, (1.70, 5.47) and age of ≥40 (AOR, 11.32; 95% CI (3.37, 37.98), being married (AOR, 3.56; 95% CI, (2.30, 6.38), having chronic illness (AOR, 3.43; 95% CI, (1.59,7.43), having suspected COVID-19 family members (AOR, 5.20; 95% CI, (2.11, 12.78), and not having an access to PPEs (AOR, 2.55; 95% CI, (1.43, 4.56) were statistically significantly associated with anxiety.ConclusionBeing married, having a chronic illness, having suspected COVID-19 family members, not having access to PPEs, and age greater than or equal to 30 years were identified as risk factors for anxiety of Healthcare Workers towards COVID-19.

Introduction. Awareness with recall of intraoperative events is an infrequent but potentially devastating complication of general anesthesia, with a reported incidence of 0.1-0.2% in low-risk patients. Higher incidence is expected in resource-limited operation room setups and in high-risk patients. Awareness can result in significant distress to patients and long-term psychological consequences, including symptoms associated with posttraumatic stress disorder, anxiety, night mares, night terror, dissatisfaction with surgical service, and sometimes even suicide. Objective. To assess the magnitude and associated factors of awareness with recall under general anesthesia in Amhara regional state referral hospitals. Method. An institution-based cross-sectional study was conducted on 1065 patients who underwent surgery under general anesthesia from January 1 to June 30, 2018. The study participants were selected by systematic random sampling from 4 referral hospitals. The modified Brice questionnaire was used to detect awareness under general anesthesia. Interviewer-administered structured questionnaire and chart review were employed. Data with complete information were entered in to SPSS version 20 computer software. Descriptive statics and bivariate and multivariable analysis were computed. A P-value less than 0.2 was used to select candidate variables for multivariable logistic regression. A P-value less than 0.05 was used to declare statistical significance. Result. 1065 patients were included in the study which makes the response rate of 90.7%. The magnitude of awareness with recall under general anesthesia was found to be 8.2% of which 4.9%, 2.6%, and 0.7% of patients reported hearing voice, pain, and sensation of breathing tube, respectively. Lack of premedication was the only significantly associated factor for awareness with recall under general anesthesia (AOR = 3.014, 95% CI (1.201 to 7.565)). Conclusion and Recommendation. Our study showed higher magnitude of awareness with recall under general anesthesia. Lack of premedication was the only associated factor with awareness with recall under general anesthesia. Anesthetists should give emphasis to prevent the possibility of awareness under general anesthesia by providing premedication. Cohort studies should be done including the consequences of awareness with recall under general anesthesia.

Introduction. The significance of difficult or failed tracheal intubation following induction is a well-recognized cause of morbidity and mortality in anesthetic practice. Nevertheless, the need to predict potentially difficult tracheal intubation has received a little attention. During routine anesthesia, the incidence of difficult tracheal intubation has been estimated at 1.5%–8% of general anesthetics. Difficulties in intubation have been associated with serious complications, such as brain damage or death, particularly when failed intubation has occurred. Occasionally, in a patient with a difficult airway, the anesthetist is faced with the situation where mask ventilation proves difficult or impossible. This is one of the most critical emergencies that may be faced in the practice of anesthesia. If the anesthetist can predict which patients are likely to prove difficult to intubate, he/she may reduce the risks of anesthesia considerably. In Ethiopia, there are no data on the magnitude of difficult laryngoscopic tracheal intubation and no standard guidelines for preoperative tests. The main concern of this study was to provide information on the magnitude of difficult laryngoscopic intubation and to determine valuable preoperative tests to predict difficult laryngoscopy and intubation in patients with apparently normal airways which can help anesthetists to improve preoperative airway assessment and contribute to decrease anesthesia-related morbidity and mortality. Objective. The main objective of this study was to assess the magnitude and predictive values of preoperative tests for difficult laryngoscopy and intubation, among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation in Tikur Anbessa Hospital from February 1 to March 30, 2016. Study Design. A facility-based cross-sectional study design was used. Result. In this study, we found the magnitude of difficult laryngoscopy and intubation as 13.6% and 5%, respectively. 33.3% of patients with difficult laryngoscopy were found to be difficult for intubation. Mallampati test, interincisor distance, and thyromental distance were identified to be good preoperative tests to predict difficult laryngoscopic intubation when used in combination. Recommendation. We recommend anesthesia professionals to use combination of MMC/TMD/IID for their routine preoperative airway assessment.

Background: Aspiration of a foreign body (FB) is the act of unintentionally ingesting food, drink, or typically items. In every country on earth, it is the main cause of death. Aspirations of a foreign body in kids are typically emergency situations and account for a significant part of accidental fatalities. Problems are made worse by a lack of community understanding about foreign body aspiration., Objective: To assess the level and determinants of knowledge, attitude, and practice towards the first aid management of foreign body aspiration and airway obstruction among kindergarten teachers in northwest Amhara, Ethiopia, 2022., Methods: An institution-based cross-sectional study was undergone on kindergarten teachers., Result: The result of this study showed that 78.4% of the participants had good knowledge or scored equal or more than the mean score. The total score of the attitude was calculated by rating the respondent's correct-full responses on the attitude questions; a total of 337 (93.4%) answered all the six questions above the mean level of 5.98, indicating that 93.4% of the respondents have a positive attitude., Discussion: In the present study, 78.4% of kindergarten teachers demonstrated good knowledge. In contrast, a study conducted in Addis Ababa, and Ethiopia, revealed that only 37% of participants exhibited good knowledge regarding foreign body aspiration management, significantly lower than the current study's findings. Additionally, the same study found that 93% of kindergarten teachers held a positive attitude toward foreign body aspiration management, aligning with the results of a cross-sectional study in Addis Ababa, and Ethiopia, where the attitude score was 95.1%., Conclusion and Recommendation: The result of this research shows that majority participants of this study have good knowledge and attitude towards foreign body aspiration management, but poor practice about it., Competing Interests: The authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Informed consent discussions are individualized not only with regard to the patients' surgical condition and goals but also with their varying information needs, health literacy, and anxiety. Information is lacking regarding the views of patients and concerned healthcare professionals on the informed consent process., Objective: This study is aimed to explore patients' and healthcare professionals' perceived barriers during informed consent process and identify suggested solutions for improvement., Methods: Patients who underwent elective surgery, anesthetists, and surgeons were the subjects of a qualitative study employing focused group discussions and in-depth interviews. The study participants were chosen through the use of purposeful sampling., Results: The main barriers identified by the patients include: inadequate explanation about the intended procedure, family's influence in the decision-making, fear of surgery, fear of light/power interruption, inadequate time for discussion, and not letting the family members attend the discussion. On the other hand, healthcare professionals also identified various barriers, which includes: inability of patients to understand the information, limited time to discuss with patients in detail, poorly designed informed consent form, poor awareness of patients, fear of patient refusal for surgery if the risks and associated health problems are explained, lack of adequate investigation to confidently explain about the disease condition, use of medical jargons, poor documentation habit of professionals and lack of legal system regarding ethical dilemmas., Conclusions and Recommendation: Patients and healthcare professionals have identified avoidable barriers that need the attention of concerned health professionals, educators, and the healthcare delivery system., Competing Interests: The authors report no competing of interests in this study., (© 2023 Negash et al.)

Lymphatic filariasis (LF) and onchocerciasis (OV) are among the neglected tropical diseases (NTD) targeted for elimination in Ethiopia. We used a transmission assessment survey (TAS-1) to evaluate the serological status of OV in three co-endemic districts in Gambella simultaneously. During May and June 2019, blood samples were collected from 6- to 7-year-old children who were randomly selected through standard community-based TAS methodology. Children were tested for both circulating filarial antigen (CFA) for LF via filariasis test strip and for Onchocerca volvulus 16 (Ov16) antibody for OV via laboratory-based ELISA. A total of 3,377 children from 150 villages in the three districts were tested; 1,823 (54.0%) were male. All three districts had CFA results below the critical threshold for stopping LF mass drug administration (MDA). In contrast, 40 children (1.2%) were positive for Ov16 antibody, well above the WHO's OV stop MDA threshold of 0.1%. The integrated assessment indicated two programmatic decisions: stop MDA for LF and continue MDA for OV. Accordingly, albendazole MDA was discontinued in the districts but ivermectin MDA continued. This integrated assessment showed that a random sample for TAS can give important information about OV transmission status in co-endemic areas.

Wildlife-vehicle collision (WVC) is one of the major causes of wildlife mortality and a concern for conservationists worldwide. The study of roadkill data that can be used to develop appropriate measures and strategies for both wildlife conservation and traffic safety to mitigate the WVC and animals' mortality. Extensive studies have been conducted in the developed countries on the identification of WVC hotspots and its potential impact; however, less attention is given in developing countries. Because of this, the problem is not well understood in developing countries. This study was intended to identify victim species, hotspot areas for roadkill, and factors that contribute to WVC in Jimma Zone, along three roads leading from Jimma City. Data were collected using a citizen science approach and a skilled man power road survey (March-September 2022) to document the number and type of species killed. Three road segments (135 km in total) were surveyed weekly as a baseline for future research. All statistical analyses were carried out using R-software. In the present study, a total of 84 roadkill specimens were collected from 16 different mammal species, of which 85.7% were medium-sized carnivores. The findings showed that Jackals ( Canis mesomalis and Canis adustus ) were the most frequently killed species (25%, n is 21), followed by Civettictis civetta (22.62%, n is 19). The study revealed that the major factors causing collisions include habitat type (forest cover) and wildlife behavior (nocturnal or diurnal). Further, the study revealed that the majority of WVC occurred at night (dusk) and at dawn in areas that are covered with dense forests. To minimize the potential risks of WVC and animals' mortality, we suggest putting warning signs in hotspot areas where roadkill usually occur frequently. In addition, we recommend creating awareness among drivers, traffic police, and all communities about the negative impacts and consequences of collisions on the ecological and economic value of wildlife., Competing Interests: The authors declare that they have no known competing financial or personal interests that could interfere with the work presented in this paper., (© 2023 The Authors.)

Background: The greatest risk of getting tuberculosis (TB) infection is contact with patients who have pulmonary tuberculosis (PTB). The World Health Organization (WHO) strongly recommends tuberculosis screening for all household contacts of PTB patients. However, there is no information on household contact screening adherence among PTB patients in Shashamane town., Methods: A facility-based mixed-method cross-sectional study was conducted from July 1 to November 30, 2021 among consecutively selected 392 PTB patients and 23 purposely selected key informants. Data were collected using a pre-tested interviewer administered questionnaire and leading questions. Data analysis was made using SPSS version 25 and in-depth interview information was analyzed based on thematic areas. Bivariable followed by multivariable logistic regression with 95% CI were conducted. P -value<0.05 was considered to identify statistically significant factors., Results: The overall adherence to household contact screening (HHCS) was 44.4% (95% CI: 39.3, 49.1). Having under fifteen years of contact (AOR=2.386, 95% CI: 1.44, 3.96), diploma and above education status (AOR=3.43, 95% CI: 1.286, 9.15), good knowledge (AOR=2.999, 95% CI: 1.79, 5.03), favorable attitude (AOR=2.409, 95% CI: 1.45, 4.02), getting health education (AOR=3.287, 95% CI: 1.92, 5.63) and smear positive type of PTB (AOR=2.156, 95% CI: 1.28, 3.62) were factors significantly associated with HHCS adherence. Workload, facility readiness and care provide commitments were also identified from qualitative data., Conclusion and Recommendation: HHCS adherence in our study was sub-optimal referenced to WHO and national recommendations that all household contact should be screened. Having age less than fifteen years contact, education status, knowledge, attitude, receiving health education and type of pulmonary tuberculosis were factors associated with adherence. We recommend increasing community awareness of TB, providing health education TB patients and their families, strengthening positive attitudes toward HHC screening and strengthening the commitment of health professionals to screen for HHCs., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Naga Mamo et al.)

There is a gap in evidence linking antenatal care (ANC) utilization, nutrition counseling, and knowledge of pregnant women about infant and young child feeding (IYCF), particularly in low-income settings. Therefore, this study aimed to identify the association between ANC follow-up and nutrition counseling with IYCF knowledge. A cross-sectional study was conducted among 390 pregnant women in the rural kebeles of the Harari region from January to June 2019. Data were collected using face-to-face interviews on tablet computers. Bivariate and multivariate logistic regression were employed. An adjusted odds ratio (with 95% CI) was used to determine the strength of association between IYCF knowledge with ANC follow-up and nutrition counseling by adjusting for educational status, occupation, gravida, and distance to the nearest health center. Overall, 54.4% [95% CI 49.2, 59.2] of currently pregnant women were knowledgeable about IYCF of which only 20% started ANC follow-up and 24.4% received nutrition counseling. Out of 288 multigravida women, only 51.4% had ANC follow-up during their last pregnancy. In the adjusted model, ANC follow-up during the current pregnancy (AOR 1.85, 95% CI 1.07-3.22), those who received nutrition counseling (AOR 1.92, 95% CI 1.09-3.38), literate in education (AOR 1.71, 95% CI 1.07-2.73), multigravida (AOR 1.96, 95% CI 1.12-3.43), and far from the nearest health center (AOR 0.95, 95% CI 0.93-0.97) were significantly associated with the mothers IYCF knowledge. Thus, health care providers should encourage mothers to attend ANC during pregnancy and provide nutrition counseling about the IYCF., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Roba, Tola, Dugassa, Tefera, Gure, Worku, Ayele, Dasa, Workie, Asfaw, Asfaw, Mesfin, Regassa, Dessie, Abera, Yeshitila, Girma, Gezahagn, Tezera, Assefa and Roba.)

Background: Anesthesia record is an essential part of perioperative patient management and, it is one of the global patient safety challenges. The aim of this study is to assess the completeness of perioperative anesthesia record sheets in Amhara regional state hospitals of Ethiopia., Methods: A retrospective review of anesthetic records was employed for patients who underwent surgery in Amhara Regional State Hospitals of Ethiopia from December 1, 2019, to February 29, 2020. All the intraoperative, preoperative, and postoperative data completeness of anesthesia record sheets was assessed using a structured checklist., Results: A total of 420 perioperative anesthetic records were included in this study. The basic preoperative history was documented in less than 80% of anesthesia record sheets. A physical examination was done and the results of the basic investigations were recorded in less than 75% of anesthesia record sheets. The name and dose of anesthetic medications were documented in 91% of the anesthesia records sheets. The completeness of parameters related to postoperative plans and orders was less than 70%., Conclusion: The completeness of perioperative anesthesia record was poor in Amhara regional state hospitals of Ethiopia. Anesthesia professionals should document all the necessary perioperative parameters in the anesthesia record sheet., Competing Interests: The authors have declared that no competing interests., (© 2022 The Authors.)

Background: Medicines of poor quality are currently prevailing problems undermining the quality of health care services in veterinary and human medicine. In this study, physico-chemical quality of veterinary medicines was evaluated., Methods: A total of 959 veterinary medicines samples were collected during routine regulatory activities, i.e. pre-registration, re-registration, consignment checking and post-marketing surveillance, in Ethiopia. The samples were transported to Animal Products, Veterinary Drug and Feed Quality Assessment Centre (APVD-FQAC), which is the quality control laboratory of the Veterinary Drug and Feed Administration and Control Authority (VDFACA) and stored until analysis. The samples were subjected to visual inspection and chemical analysis following the United States, European or British Pharmacopoeias, or manufacturer's methods., Results: The findings revealed that 12 (1.3%) of tested products showed defects in physical characteristics, packaging, or labelling information, while a total of 66 (6.9%) samples of the investigated products failed to comply with the Pharmacopoeias and supplier's specification limit set for assay. Of these, 60 samples did not comply with the minimum assay specification limit., Conclusion: Overall, 8.2% of the investigated veterinary medicine samples did not comply with the specification set for the investigated quality attributes and thus were categorized as of poor quality. This indicates the need for continued strengthening of regulatory functions., (© 2022. The Author(s).)

Background: 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., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Kibret et al.)

Background: Tracheal intubation is a common intervention for many pediatric surgical patients. Even though it can be lifesaving, it carries a risk of morbidity and even mortality. Evidence is lacking regarding the adverse events related to pediatric intubation in Ethiopia. This study is aimed to assess the scale of tracheal intubation-related adverse events with its associated factors in pediatrics surgical patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia., Methods: An Institutional-based cross-sectional study was conducted on 310 pediatric surgical patients who underwent major surgery from December 30, 2019, to February 30, 2020. All pediatrics patients scheduled for surgery under general anesthesia in the study period were included in this study. Data with complete information were entered into Epi Info version 7 and exported to SPSS version 22 for analysis. Descriptive statistics, bivariate, and multivariable logistic regression were computed to identify factors associated with tracheal intubation-related adverse events. The level of statistical significance was declared at a P-value of less than .05., Result: In this study, the overall incidence of tracheal intubation-related adverse events in pediatrics patients was 36.5%. Being a neonate (AOR = 4.13, 95% CI: 1.26-13.49), emergency surgery (AOR = 3.39, 95% CI: 1.41-8.13), difficult intubation (AOR, 4.08, 95% CI: 1.01-7.50), intubation without using premedication (AOR = 1.75, 95% CI: 1.45-10.83), intubation without using muscle relaxant (AOR = 1.81; 95% CI: 1.10-8.14), and tracheal intubation attempted more than three times (AOR = 3.92, 95% CI: 0.16-7.39) were identified as independent predictors of tracheal intubation-related adverse events., Conclusion and Recommendations: The incidence of tracheal intubation-related adverse events in pediatric surgical patients is high. Anesthesia professionals should be vigilant and have a preplanned strategy to avoid intubation-related adverse events, especially in high-risk patients. The use of difficult airway algorithms, oxygen saturation monitoring, and training in simulation room are very important strategies to help reduce patient harm., (© 2021 John Wiley & Sons Ltd.)

Background: Breast cancer tumours are the most common malignant tumours among women in Ethiopia. Although advanced-stage diagnosis of breast cancer is a common problem, evidence-based information is lacking about the magnitude and determinants of advanced-stage presentation in north-west Ethiopia., Methods: An institution-based, cross-sectional study was conducted at the oncology units of the University of Gondar and Felege Hiwot specialised hospitals. Stages III and IV were considered advanced stage, whereas stages I and II were considered early stages. Data were collected prospectively on newly diagnosed breast cancer patients and entered using the EPI Info version 7.2 and analysed using Statistical Package for the Social Sciences version 23. Multivariable logistic regression was used to identify the determinants of advanced-stage diagnosis of breast cancer. A p -value < 0.05 was used as the cut-off point to select the determinants of the advanced stage., Result: About 71.2% of breast cancer patients presented with advanced-stage disease. The median age of patients was 40 years. Rural residence (adjusted odds ratio (AOR) = 1.7; 95% confidence interval (CI): 1.02, 2.96), painless breast lump/wound (AOR = 2.5; 95% CI: 1.45, 4.13), travel distance ≥5 km (AOR = 3.2; 95% CI: 1.72, 5.29), not practising breast self-examination (BSE) (AOR = 2.9; 95% CI: 1.30, 6.52), time to presentation ≥3 months (AOR = 1.4; 95% CI: 1.02, 2.37) and misdiagnosed at first visit (AOR = 1.9; 95% CI: 1.09, 3.59) were determinants of advanced-stage breast cancer., Conclusion: Nearly three-quarters of the patients were diagnosed with advanced-stage breast cancer. Not practising BSE, travel distance ≥5 km, rural residence, painless breast wound/lump and being misdiagnosed at first visit were important determinants of advanced-stage diagnosis of breast cancer. Focused awareness creation programmes for the public and increasing cancer diagnostic centres in the country are crucial to downstage breast cancer at presentation., (© the authors; licensee ecancermedicalscience.)

Background: Spousal family planning communication plays an important role in making better reproductive health decisions and in increasing the use of modern contraceptive methods. The objective of the current study is to examine the association of spousal family planning communication in its broader context with current modern contraceptive use among couples., Methods: A community based cross-sectional survey was conducted in twelve kebeles of Harar Urban Health and Demographic Surveillance System. A total of 2700 currently married couples of whose wives were in the reproductive age participated in the study. The selection of the study participants was made using simple random sampling and data were collected using an interviewer administered structured questionnaire and analyzed using Stata version 12., Results: The level of current modern contraceptive use was 57.1% (95% CI: 0.53, 3.39). Effective spousal family planning communication was significantly associated with current modern contraceptive use even after controlling for socio-economic and demographic variables. Socio-economic and demographic variables such as religion of couples, number of couples' living children, household monthly income, couples' family planning approval and women's counseling about family planning by health workers were significantly associated with current modern contraceptive use., Conclusion: Policies and programs aimed at increasing contraceptive prevalence should properly address the importance of spousal communication about family planning and integrate men into family planning programs to facilitate and enhance couples communication skills., Competing Interests: The authors declared that they have no conflicts of interest for this work., (© 2021 Zelalem et al.)

Background: Hepatitis B virus (HBV) infection is a serious public health problem in sub-Saharan Africa pregnant women. HBV Infection has high tendency of vertical transmission and have adverse effect on both the mother and child. However, there is no evidence on prevalence of hepatitis B virus among pregnant women in Wolaita Zone. Therefore, this study aims to determine prevalence and associated factors of hepatitis B virus infection among pregnant attending Antenatal clinics of public Hospitals of Wolaita Zone., Method: An institution based cross sectional study was conducted among pregnant women attending antenatal clinics of Wolaita Zone from October-November, 2018. Systematic random sampling was used to get respondents. A pretested, structured questionnaire was used to collect socio-demographic characteristics and other variables. In addition, 5 ml of venous blood was collected from each study participants and serum was tested for Hepatitis B surface antigen. Data was entered to Epidata 3.1 version and exported Statistical Package for Social Sciences Version 20.0 for descriptive and logistic regression analysis. All variables in bivariate analysis with p<0.25 were taken to multivariable analysis. P-value and Odds ratio with 95% CI was used to measure the presence and strength of the association respectively., Result: The prevalence of Hepatitis B surface Antigen among pregnant women was 49(7.3%). History of multiple sexual partners (AOR = 2.675, 95%CI = 1.107-6.463), surgical procedure (AOR = 3.218, 95%CI = 1.446-7.163), genital mutilation (AOR = 2.72, 95% CI = 1.407-5.263), and tooth extraction (AOR = 2.049, 95%CI = 1.061-3.956) were statistically associated with HBV., Conclusion and Recommendation: Intermediate endemicity of Hepatitis B Virus (7.3%) was observed among mothers attending antenatal clinics of Wolaita Zone. History of tooth extraction, history of surgical procedure, history of genital mutilation and history multiple sexual partners were factors associated with acquisition of Hepatitis B Virus infection. Therefore, we recommend that the health education programs should be done to avoid traditional and non-sterile tooth extraction methods, female genital mutilation and avoiding having multiple sexual partner and its consequences to community and to raise the awareness of mothers attending antenatal clinics. Facilities should strictly follow sterile procedures in every surgical procedure., Competing Interests: All Authors have no conflict of interest.

Background: WHO does not recommend community-level health workers (CLHWs) using integrated community case management (iCCM) to treat 7-59 days old infants with fast breathing with oral amoxicillin, whereas World Health Organization (WHO) integrated management of childhood illness (IMCI) recommends it. We want to collect evidence to help harmonization of both protocols., Methods: A cluster, randomized, open-label trial will be conducted in Africa and Asia (Ethiopia, Malawi, Bangladesh and India) using a common protocol with the same study design, inclusion criteria, intervention, comparison, and outcomes to contribute to the overall sample size. This trial will also identify hypoxaemia in young infants with fast breathing. CLHWs will assess infants for fast breathing, which will be confirmed by a study supervisor. Enrolled infants in the intervention clusters will be treated with oral amoxicillin, whereas in the control clusters they will be managed as per existing iCCM protocol. An independent outcome assessor will assess all enrolled infants on days 6 and 14 of enrolment for the study outcomes in both intervention and control clusters. Primary outcome will be clinical treatment failure by day 6. This trial will obtain approval from the WHO and site institutional ethics committees., Conclusions: If the research shows that CLHWs can effectively and safely treat fast breathing pneumonia in 7-59 days old young infants, it will increase access to pneumonia treatment substantially for infants living in communities with poor access to health facilities. Additionally, this evidence will contribute towards the review of the current iCCM protocol and its harmonization with IMCI protocol., Trial Registration: The trial is registered at AZNCTR International Trial Registry as ACTRN12617000857303., Competing Interests: Conflict of interest: None declared

Though the incidence of gout in general population is less than 5% (globally), a study conducted in Eritrea among patients with multidrug resistant tuberculosis (MDR-TB) revealed a higher incidence (25%). Other similar studies conducted elsewhere, however, did not report gout as an adverse effect. It is unknown why a higher incidence of gout is being reported in Eritrea compared to similar studies from other countries. The objective of this study is therefore to explore risk factors for the increased risk of incident gout among MDR-TB patients in Eritrea. A case-control study was conducted in Merhano MDR-TB National Referral Hospital in Eritrea. All MDR-TB patients diagnosed with gout between June 2011 and June 2018 were considered as cases. Controls matched by age, sex, and cumulative drug exposure time were selected from the same study population (1:1 ratio). A total of 84 MDR-TB patients, 42 cases and 42 controls, were included in this study. No patient from the control group has comorbidities, while six patients from the case group have diabetes ( χ 2 = 6.46, df=1, p=0.026). Patients having tachycardia (OR=3.26, 95% CI=1.28, 8.27), alopecia (OR=3.11, 95% CI=1.00, 9.67), and gastrointestinal upset (OR=3.17, 95% CI=1.26, 7.96) as adverse effects and being on prolonged use of propranolol (OR=3.26, 95% CI=1.28, 8.27) were found to be more likely to develop incident gout compared to their controls. In conclusion, MDR-TB patients with diabetes mellitus, tachycardia, alopecia, and gastrointestinal upset and on prolonged use of propranolol tablet had increased risk of incident gout.

Background: Parasitic diseases are the main challenge of livestock production in the world. They are mainly controlled by the use of anthelmintic drugs. To be effective, the drugs should contain the appropriate amount of active pharmaceutical ingredient (API) and have the required physical characteristics. In this study, qualitative and quantitative assessments were performed to evaluate the quality of different brands of albendazole tablets legally circulating in pharmaceutical markets of Addis Ababa, Ethiopia., Methods: Ultraviolet-Visible Spectroscopy (UVS), Fourier Transform Infrared Spectroscopy (FTIR) and High-Performance Liquid Chromatography (HPLC) were used for identification. Quantitative analysis was performed by HPLC. United States Pharmacopeia standard was used as a control to evaluate the identity and content of the API in the samples. A total of 10 batches of albendazole tablets from six different brands were collected and evaluated., Results: All brands of albendazole tablets, except one, had acceptable physical characteristics. There was gross contamination in one batch, weight variation in 4 (40%) batches, and absence of package insert in 2 (20%) batches. All three methods of evaluation (UVS, FTIR and HPLC) confirmed that all batches passed the identity test. Quantitative analysis showed that no batch had API above the acceptable limit. However, 30% of batches from three different brands contained lower amount of API per tablet than the acceptable limit., Conclusions: All batches of albendazole circulating in the market in Addis Ababa did not fulfil either physical or chemical quality standards. The most important finding of this research was the presence of drugs with lower level of API than the acceptable limit. This can lead to treatment failure and favour the emergence of parasites that are resistant to drugs. Therefore, there should be a thorough evaluation of drugs before approval. The study also revealed the importance of occasional assessment of drugs circulating even in the legal market.

Background: Iodine deficiency is one of a major nutritional problem. The study aimed to assess the iodine status of populations in Dabat district using median urinary iodine concentration (UIC) in school-age children (6-12 years) and compared the results with goiter prevalence., Methods: The study used a cross-sectional study design. The study was conducted in Dabat district, northwest Ethiopia in May 2016. Spot urine samples were used for the determination of UIC. Manual examination of the thyroid gland was performed to assess presence of goiter. The MBI international Rapid Test Kits (RTK) were used to determine the level of salt iodine content. Children aged 6-12 years were recruited from schools using a multistage stratified sampling. One-way Analysis of Variance (ANOVA) was used to compare mean of log-transformed UIC values among key variables. Significant was determined at P -value less than 0.05., Results: A total of 358 school age children enrolled to the study. The mean age of children was 10.8((Standard Deviation (SD) = 1.45) years and 56.7% were males. The median UIC was 235 μg/l ((Inter Quartile Range (IQR): 161, 320]. Excessive iodine intake and inadequate iodine intake was observed on 29.1 and 8.7% of school aged children, respectfully. The coverage of iodized salt use in school-age children were 66.8%. The UIC was higher in urban children than rural counterparts and in those used adequately iodised salt than inadequately iodized salt ( P  < 0.05). Thirty-four percent of school-age children had a goiter. The prevalence of grade 1 and grade 2 goiter was 26.5 and 7.5%, respectively. There was a poor agreement between UIC and goiter ( k  = 0.1) in classifying iodine status of populations., Conclusions: The study population is classified as above requirements by median UIC in school-age children but severe iodine deficiency by goiter prevalence. Further research investigating the agreement between UIC and goiter prevalence in classifying iodine status of populations with various iodine status is warranted., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2018.)

Existing literatures from developing countries show an increased mortality and morbidity related to hepatitis E virus during pregnancy as compared to the general population. Studies focusing on pregnant women are required for policy makers to improve maternal and child health. Therefore this study is aimed at determining the prevalence and associated risk factors of hepatitis E virus infection among pregnant women attending the health facilities of Tigray region, Northern Ethiopia. In this cross sectional study 846 pregnant women were included consecutively from April 2014 to February 2016. Clinical and sociodemographic were collected using structured questionnaire and blood was collected for laboratory analysis of Hepatitis E virus using IgG and IgM HEV ELISA. The data were analyzed using SPSS software version 21.0. Association with variables with the risk factors was determined using bivariate and multivariate analysis. The overall sero-prevalence of hepatitis E virus using anti-HEV IgG and anti-HEV IgM antibody among pregnant women were 367 (43.4%). From this 359 (42.4%) and 8 (0.9%) were tested positive for anti-HEV IgG and anti-HEV IgM antibody, respectively. Then finally age, rural residence, not washing after toilet use and lack of prevention aspects to minimize contamination were associated with HEV infection. This study shows the significant public health impact of HEV during pregnancy in low income countries., (© 2018 Wiley Periodicals, Inc.)

Background: Cotton dust induced respiratory disorders are dramatically increased over the globe, especially the problem is serious in developing countries. Respiratory symptoms, such as cough, phlegm, wheezing, shortness of breath, chest tightness, chronic bronchitis, and byssinosis are common among workers exposed to cotton dust. However, in Ethiopia, the magnitude of the problem is not well known and information is limited about the risk factors. Therefore, this study was aimed to assess the prevalence of respiratory symptoms and associated factors., Methods: A Comparative cross-sectional study design was employed. A total of 413 (276 exposed and 137 unexposed) participants were included in the study. Stratified and simple random sampling techniques were used to select exposed and unexposed groups to cotton dust respectively. Multivariable binary logistic regression analyses was performed to identify variables associated with respiratory symptoms and adjusted odds ratio (AOR) was used to determine the strength of associations. Significance level was obtained at 95% confidence interval (CI) and p -value ≤0.05., Results: The prevalence of self-reported respiratory symptoms was 47.8% (95% CI: 41.3, 53.7%) and 15.3% (95% CI: 9.6, 22.3%) among exposed and control groups respectively. Sex (AOR = 2.1, 95% CI: 1.29, 3.45), service year (AOR = 2.38, 95% CI: 1.19, 4.71) and ventilation (AOR = 2.4, 95% CI: 1.17, 4.91) were factors significantly associated with respiratory symptoms. Furthermore, working department such as; ginning (AOR = 5.1, 95% CI: 2.13, 12.16), spinning (AOR = 4.96, 95% CI: 2.18, 11.29), weaving (AOR = 5.9, 95% CI: 2.46, 14.27) and blowing working departments (AOR = 5.14, 95% CI: 1.4, 18.94) were significantly associated with respiratory disorders., Conclusions: The prevalence of self-reported respiratory symptoms was higher among workers exposed to cotton dust than unexposed workers. Sex, service year, working department and work unit ventilation were predictor variables for respiratory symptoms. Thus, reducing exposure to dust, adequate ventilation and improving the hygiene of working departments are needed to reduce respiratory symptoms., Competing Interests: The study was conducted after ethical clearance was obtained from Institutional Review Board (IRB) of University of Gondar, College of Medicine and Health Sciences. The copy of the ethical clearance was submitted to company manager of the industry and data were collected after getting informed verbal consent from the manager and workers. The purpose of the study was explained and confidentiality of the information was assured. Privacy was also ensured during the interview.Privacy and confidentiality of information given by each respondent was kept properly and personal identifiers were removed.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: In Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery., Objective: To assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City Administration., Methods: A facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility., Results: Among 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83)., Conclusion and Recommendation: In this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers.

Background: Although there are established drugs for treatment of cardiovascular diseases, due to adverse effects these drugs may not be clinically applicable to all patients. Recent trends have seen the emergence of drugs which act on funny current channels to induce selective heart rate reduction. Ivabradine is one such drug developed for coronary artery disease and heart failure. There is inconsistent evidence about the effect of this selective inhibitor in reduction of cardiovascular related mortality and morbidity. Such an inconsistency warrants the need for a meta-analysis to consider the effectiveness and efficacy of Ivabradine in the treatment of coronary artery disease and heart failure., Methods: Randomized controlled trials with a minimum follow-up period of one year were searched in Pub Med/Medline, Embase, Cochrane Central Register of Controlled Trials published between 1980 and 2016.Each eligible study was assessed for risk of bias by using the Cochrane Risk of Bias Assessment tool. The outcomes assessed in this study included: all cause mortality, cardiovascular-related mortality, hospitalization for new or worsening heart failure, and adverse events. Subgroup analysis and publication bias were assessed. We used Mantel-Haenszel method for random-effects. Analysis was done using RevMan5.1™.This study was registered in PROSPERO as [PROSPERO 2016:CRD42016035597]., Result: Three trials with a total of 36,577 participants met the meta-analysis criteria. Pooled analysis showed that ivabradine is not effective in reducing cardiovascular deaths (OR: 1.02; CI:0.91-1.15,P = 0.74), all-cause mortality (OR:1.00; CI:0.91-1.10,P = 0.98), coronary revascularization (OR: 0.93, CI: 0.77-1.11, P = 0.41) and hospital admission for worsening of heart failure (OR: 0.94, CI: 0.71-1.25, P = 0.69). However, the drug was found to significantly increase adverse events: phosphenes (OR:7.77, CI: 4.4-14.6,P < 0.00001), blurred vision (OR:3.07,CI:2.18-4.32,P < 0.00001), symptomatic bradycardia (OR: 6.23, CI: 4.2-9.26, P < 0.00001), and atrial fibrillation (OR: 1.35, CI: 1.19-1.53, P < 0.0001). Subgroup analysis by duration of follow up on cardiovascular outcomes found that there is no difference in effect of ivabradine depending on the duration of follow up. There was no publication bias in reporting of included studies., Conclusion: This meta-analysis suggests that ivabradine is not effective in reducing cardiovascular-related morbidity and mortality unless used for specific conditions. On the contrary, the use of this drug was strongly associated with the onset of untoward and new adverse events. This finding strongly supports previous findings and further informs the rational and evidence-informed clinical use of ivabradine.

Background: Unmet need for family planning is a major problem of developing countries. Evidences about unmet need for family planning and associated factors are not enough in Dangila town. Therefore, this study was done to assess the magnitude and determinants of unmet need for family planning among currently married women in Dangila town., Methodology: Community based cross sectional study design was used to collect data from a total of 551 currently married women from February to March 2014. Data were collected using pretested structured interviewer administered questionnaire after written consent was obtained from respondents. Collected data were edited, coded, and entered to SPSS version 16.0. Bivariate and multivariable logistic regression analyses were done to identify determinants of unmet need for family planning., Results: This study revealed that 17.4 % of married women had unmet need for family planning. In this study, women who were housewife/farmers were about 7 [OR = 6.81 (1.91-24.29)] times more likely to have unmet need compared to employed women. Women who were not counseled about family planning by health workers [OR = 6.76 (3.17-14.42)], women whose partner had non-supportive attitude for family planning use [OR = 3.34 (1.26-8.90)] and rural women [OR = 17.65 (4.35-71.67)] were also more likely to have unmet need for family planning. About 33 %, 32 %, 23.5 % and 11.8 % of women mentioned less perceived risk of pregnancy due to breast feeding, fear of side effects, partner opposition and religious prohibition respectively as reasons for not using contraceptives at the time of interview., Conclusions: The level of unmet need for family planning in the study area is still high compared to the target set (10 %) in the national family planning guide plan of Ethiopia to be achieved by the end of 2015. Therefore, it is important to strengthen counseling and partner involvement in Dangila town to reduce unmet need for family planning.

Background: Removal of a tumor involving both the intracranial space and the skull presents technical challenges. This is especially so if there is a potential for significant hemorrhage due to a hemangioma or a significant attachment to the brain as with a meningioma., Case Description: We describe a technique where the tumor attached to the skull is left undisturbed and a second wider concentric craniotomy exposes normal dura. The entire tumor, both intracranial and that involving the skull and dura, can then be removed as one specimen., Conclusion: The technique we describe, a concentric craniotomy, transforms a difficult operation with the potential for significant hemorrhage into a more standard removal of a convexity tumor., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Antenatal care (ANC) is one of the evidence based interventions to decrease the probability of bad health outcomes for mothers and their newborns. Effectiveness of antenatal care, however, relies on the quality of care provided during each antenatal care visit. Hence this study attempted to assess the quality of antenatal care services at public health facilities of Bahir-Dar special zone, North Western Ethiopia., Methods: A facility based cross-sectional study employing both quantitative and qualitative methods was conducted from March to April 2010 in Bahir-Dar special zone, North Western Ethiopia. Quality of care was measured as a proportion of patients receiving recommended components of care. To measure the indicators, data was collected from 369 pregnant women who attended ANC clinics in eight public health facilities, during the data collection period. Data were collected through exit interviews with ANC attendees, observation during consultation, and in-depth interviews with health care providers., Results: Pregnant mothers attending ANC clinics were found to receive only part of recommended care components. Venereal Disease Research Laboratory (VDRL) test, blood group and Rhesus factor tests were done only for 73 (19.8%) and 133 (36.0%) of the women, respectively. Moreover 236 (64.0%) of the mothers missed the opportunity of receiving iron/folic acid supplement during their ANC visit. Three hundred fifty five (96.2%) of the women received tetanus toxoid vaccine. And only 226 (61.2%) of the women had their conjunctiva checked for anemia. Lack of reagents partly explained the problems observed in the provision of recommended care components., Conclusion: Almost half, 175 (47.7%) of the study women were not satisfied and a large proportion of mothers are missing opportunities to receive screening (like blood pressure and weight measurements) and preventive components of antenatal care (iron/folic acid supplementation). Therefore, efforts should be targeted to avoid missed opportunities by taking quality improvement measures including the fulfillment of all necessary resources.

Current strains of fowlpox virus (FWPV) carrying circulating reticuloendotheliosis virus (FWPV-REV) sequence are becoming more pathogenic to poultry. This is evidenced by the fact that vaccination with current available FWPV vaccines provides limited protection against them. To characterize REV insertions in a collection of both older and more recent field isolates, we developed three different types of adjacent oligoprobes and primer sets from specific genomic locations of FWPV and REV: REV-ENV (accession no. K02537, 1382-2260), FWPV-REV integration site (accession no. AF006064, 86-1328), FWPV (accession no. AF198100, 232461-232670), and REV-LTR (accession no. V01204, 305-496). The data indicated that the primers from the REV-ENV region and the TaqMan probes specifically targeted REV-ENV sequences of FWPV-REV strains. Furthermore, the strains were differentiated based on quantitative melting temperature (T(m)) of their amplified products using FRET-based probes. The amplified products were further characterized by sequencing and multiple sequence alignment analysis. The results suggest that integrated REV-ENV sequences are both common and mostly conserved in field isolates. However, the minor variations found within the short-targeted ENV sequence from FWPV-REV strains suggest that these strains could have either undergone periodic point mutational changes or integration with different REV-ENV subtypes.

A concurrent infection of chickens with infectious laryngotracheitis virus (ILTV), a herpesvirus, and fowlpox virus (FWPV), an avipoxvirus, is described. Two techniques, an immunohistochemistry (IHC) technique and a multiplex polymerase chain reaction (PCR), were used to examine 11 tissue samples from chickens clinically diagnosed as FWPV-infected, but only IHC was used to examine six tissue-paraffin blocks prepared from turkeys suspected of having FWPV infection. By multiplex PCR, both FWPV and ILTV were detected from three chicken samples (FI-90, FI-93, and FI-94); both FWPV and ILTV were detected from only two samples (FI-93 and FI-94) by IHC. All chicken samples were positive for FWPV by both PCR and IHC. Viral DNA from these samples was further confirmed by restriction enzyme analysis. When turkey samples were analyzed by the double-stain IHC, all six samples showed the presence of FWPV antigens, but no ILTV antigens. The double IHC technique, using monoclonal antibodies against FWPV and ILTV, was successful in simultaneous demonstration of specific FWPV and ILTV antigens colocalized in infected tissue samples as well as within individual cells. This paper emphasizes the importance of reliable tests that detect specifically the presence of ILTV and FWPV in infected tissue samples. The multiplex PCR assay holds potential to be versatile, rapid, and more sensitive (100%) than IHC (67%) for the simultaneous detection of two different avian viruses. Furthermore, the presence of mixed infection should always be kept in mind in the virologic analysis of respiratory sickness of poultry.

The detection is described of reticuloendotheliosis virus (REV) protein in tissue culture of chicken embryonated cells (CEFs) infected with field isolates of fowl poxvirus (FPV). By the polymerase chain reaction (PCR), five out of the six field isolates, but two out of the seven vaccine strains of FPV, were found to have had a 291 bp repeat sequence of REV-LTR integrated in their genomic DNA. An immunofluorescence (IF) method was employed using a monoclonal antibody (MAb) known to specify strain common envelope proteins for REV and allowed to detect the presence of a specific REV protein. The IF results indicate the localization of REV proteins in boundaries defined precisely within cells infected with these field strains of FPV carrying REV (FPV-REV). Furthermore, by immunoblotting (IB) using a chemiluminescent detection kit, the REV protein reacted specifically with the MAb and had a relative molecular mass (RMM) of 62 kDa. The data have the potential to advance substantially the current understanding of the integrated REV in FPV strains; and the identification of a unique protein associated with variant forms of FPV will also offer great potential for identification of novel vaccine candidates for use in poultry against variant forms of FPV.

Restriction deoxyribonucleic acid (DNA) fragment profile analysis coupled with immunogenic protein profile analysis has provided useful information in determining the differences between vaccine strains and field isolates of fowlpox virus (FPV). The DNA of strains examined in this study clearly fell into 3 minor groups of restriction patterns similar but distinct from one another: restriction patterns exhibited by the vaccine strains except 1 vaccine strain, Vac-82; restriction profiles indicated by Vac-82 and field isolates FI-38 and FI-42; and restriction patterns indicated by field isolates FI-43, FI-51, FI-54, and FI-56. Furthermore, when the strains were analyzed and compared by immunoblotting analysis, they showed group differences similar to the differences in restriction profiles. Both techniques provided high sensitivity in verifying differences between vaccine strains and field isolates of FPV. The disparity found in restriction fragments or immunogenic protein profile between vaccine strains and field isolates does not exclude the appreciable high degree of DNA sequence conservation and homology. However, the minor disparity observed in these strains suggests a molecular basis for why vaccinated commercial flocks could have continually been infected by variant strains of FPV. A rapid and sensitive polymerase chain reaction method, which amplified a product from the 4b core protein gene of the FPV genome, was developed for identification and differentiation of members of the genus Avipoxvirus. Whereas total DNA from either vaccine strains or field isolates was used as template for amplifying a predicted product of 578 or 1409 bp, only cleavage of the amplified product (1409 bp) represented an additional detection technique for species differentiation. An attempt to distinguish between strains on the basis of amplification product was partially successful.

A mixed-antigen agar gel enzyme assay (AGEA) was developed to detect antibodies to poxviruses in chicken and turkey sera. The assay combines the principles of immunodiffusion and enzyme assay. For the detection of antibodies to fowl poxvirus (FP), pigeon poxvirus (PP) and turkey poxvirus (TP) in turkey serum samples, the three antigens were combined to form a mixed-antigen assay. To screen for antibodies to FP and PP in chicken serum samples, the two antigens were combined. When FP and PP viruses were combined as antigens, the sensitivity for chicken sera was 64% but the sensitivity of the agar gel precipitation test (AGPT) was 34% (P<0.001). When antibodies were detected in turkey sera using the mixed antigens, the AGEA had a sensitivity of 66.4% while that of AGPT was 25% (P<0.001).