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Background: Antimicrobial resistance (AMR) is leading health care in developing countries into a down-ward spiral. Scarcities in clinical microbiology laboratories compounded by lack of awareness on antimicrobial stewardship and unregulated durations of antimicrobial use are leading to sub-optimal clinical outcomes. The objective of the study was to assess recommendations for duration of antimicrobial treatment suggested by pediatric residents and pediatricians in Addis Ababa, Ethiopia in comparison with guidelines published by internationally recognized bodies.Methods: This was a descriptive cross-sectional study conducted from 1st February and 31st July, 2020. Data on durations of antimicrobial prescriptions suggested for infectious syndromes were collected from pediatricians and pediatric residents working and training in Addis Ababa, Ethiopia. Responses on deficiencies and excesses in recommendations for durations of treatment were summarized using descriptive quantitative analysis and their conformity to practice recommended by internationally recognized guidelines was evaluated. Differences between sub-groups was determined by the Mann-Whitney U test (SPSS 25.0). Analyses were done using Statistical package for the social sciences (SPSS) version 20.0 and significant differences ascertained at p-value < 0.05. Results: A total of 88 respondents participated in the study: 48 residents and 40 pediatricians. Many respondents suggested prescription days exceeding guideline recommendations for common pediatric infections; notably for bacterial conjunctivitis, cystitis, cellulitis and lower respiratory infections. Antimicrobial therapy durations often came short of standard recommendations for tonsillopharyngitis, amebiasis and pyomyositis. Pediatricians favored less prescription days for bacterial endocarditis, hospital acquired pneumonia, cystitis and bacterial conjunctivitis. Inter-group differences were significant in prescribing for meningococcal meningitis, otitis media, Candida central line blood stream infections and non-gonococcal septic arthritis. Overall, respondents suggested 11,828.6 prescription days in excess of guideline recommendations.Conclusions: We found prescription days offered by pediatric residents and pediatricians practicing in Addis Ababa, Ethiopia to be beyond or less than durations of therapy recommended by guidelines for most childhood infections. Observance of evidence-based antimicrobial guidelines leads to favorable patient outcomes, fewer drug-related toxicities and prevention of antimicrobial resistance.

An European pediatric pulmonologist successfully organized a 2-year in-house pediatric pulmonology training with simultaneous establishment of the first pediatric pulmonary center in Ethiopia. Collaboration of the local institution with a non-governmental organization (NGO) facilitated the realization of the program. Training cost was significantly low compared to the expected out of country training, with extra financial benefit enabling purchase of equipment for the center. Our experience shows that specialists from developed countries can be instrumental to establishing cost-effective training programs and founding of specialized services in low-income countries by training subspecialists in their own setting. NGOs and leading international professional societies can support such programs to relieve the suffering of the child who “can’t breathe” because s/he is born in a low income country.

Abate Yeshidinber Weldetsadik,1 Abayneh Girma Demisse2 1St Paul’s Hospital Millennium Medical College, Department of Pediatrics and Child Health, Pediatric Respiratory and Intensive Care Division, Addis Ababa, Ethiopia; 2St Paul’s Hospital Millennium Medical College, Department of Pediatrics and Child Health, Addis Ababa, EthiopiaCorrespondence: Abate Yeshidinber Weldetsadik, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, Email yeshidinbera@yahoo.comBackground: Re-expansion Pulmonary Edema (RPE) is a non-cardiogenic form of pulmonary edema which occurs following rapid lung expansion after drainage of significant pneumothorax or pleural effusion, and rarely following resection of obstructive mediastinal mass. RPE is a rare but potentially fatal phenomenon with only few case reports in the pediatric literature.Methods: We are reporting a case of RPE in a 5-year-old girl following drainage of pneumothorax who succumbed to worsening hypoxemia despite therapy with mechanical ventilation and other supportive care.Conclusion: RPE should be anticipated, and early preventive, diagnostic and therapeutic measures should be instituted in high-risk patients who require significant pleural fluid or air drainage.Keywords: pulmonary edema, re-expansion, pneumothorax, pleural effusion, chest tube, Ethiopia

Abate Yeshidinber Weldetsadik,1 Mahlet Abayneh,1 Mebratu Abraha,2 Sisay Sirgu,3 Delayehu Bekele4 1Department of Pediatrics and Child Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Research Directorate, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 4Department of Obstetrics and Gynecology St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Abate Yeshidinber Weldetsadik, Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, PO. Box 1271, Addis Ababa, Ethiopia, Tel +251 911993975, Email abate.yeshidinber@sphmmc.edu.etIntroduction: Most previous pediatric COVID-19 studies reported milder disease in children. However, there are limited pediatric data from low-income settings. We aimed to assess the characteristics and outcomes of pediatric COVID-19 in Ethiopia.Setting: St. Paul’s COVID-19 treatment center; a tertiary COVID-19 center. Pediatric care was provided in a dedicated ward but with a common ICU.Methods: St. Paul’s Hospital COVID-19 cohort (SPC-19) included inpatient COVID-19 RT-PCR confirmed cases from August 2020 to January 2021. Data were extracted from case report forms attached to patient charts and completed by the clinicians. Data were uploaded into the Redcap database and exported to SPSS 20 for analysis. Binary logistic regression and chi-square test were used in the analysis.Results: Seventy-nine patients 0– 19 years were included from the SPC-19 cohort over 6 months. Pediatric admissions accounted for 11% of cases in the cohort. The mean age (SD) was 6.9 (± 6.36) years and 40 (50.6%) were female. The disease was asymptomatic or mild in 57 (72.2%), moderate in 15 (19%), and severe or critical in 7 (8.8%). The commonest presentations in symptomatic children were prostration (26.6%) followed by vomiting (12.7%), fever and cough (11.4% each), and dyspnea (10%). About 53 (67%) children had multimorbidity, and 14 (17.7%) children died. All deaths were in children with comorbidities with tuberculosis and malignancy being associated with 43% of deaths. Nearly 5% of children reported long-COVID symptoms highlighting the need for prolonged follow-up in those children.Conclusion: Despite lower admissions and severity, high mortality and morbidity was documented in our pediatric cohort. The presence of comorbidity and inadequate care organization likely contributed to high mortality. COVID-19 centers of low-income settings should emphasize optimizing the care of children with COVID-19 and multimorbidity, and vaccination should be considered in those children to prevent high morbidity and mortality.Keywords: child, inpatient, COVID-19, cohort studies, multimorbidity, Ethiopia

Previous work at St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, demonstrated a need for genetic counseling (GC) services, with 4% of pediatric, neonatal intensive care, and prenatal patients identified as having indications for genetic evaluation (Quinonez et al, 2019). The aim of this study was to investigate SPHMMC patients' familiarity with, knowledge of, and attitudes toward GC services. Surveys were adapted from previous work in North America populations (Riesgraf et al, 2015 and Gemmell et al, 2017) and administered to 102 patients, and results were compared to North American populations using Student's t test. 30% of respondents reported at least some familiarity with GC, primarily via the media or healthcare providers. Patients had generally positive attitudes toward GC, reporting they would trust information provided by a genetic counselor and that GC is in line with their values. Knowledge of GC showed similar trends overall when compared to results from North American populations. Our work indicates limited exposure to GC in this population, but generally positive feelings toward GC. Patients' attitudes toward GC were comparable to rural North American populations surveyed using the same tool on most items; however, cultural differences including views on abortions and directiveness of healthcare providers could account for discrepancies and are important considerations when implementing genetic services globally.

Background In low and middle-income countries (LMICs), severe pneumonia with hypoxemia is the leading cause of child deaths, even with the provision of WHO-recommended antibiotic therapy, oxygen therapy and other supportive care. Previous studies found positive outcomes from the use of bubble continuous positive airway pressure (bCPAP) for treating these children compared to the standard oxygen therapy. Due to lack of data on the perceptions and experiences of hospital health care workers and caregivers of children on the feasibility and acceptability of bCPAP in treating children with severe pneumonia and hypoxemia in real-life settings, we examined these issues in tertiary and general hospitals in Ethiopia. Methods As part of a three-stages clinical trial, this qualitative study was conducted in two tertiary (stage I) and two general (stage II) hospitals from September 2019 to July 2020. During stages I and II, we have consecutively enrolled children with severe pneumonia and hypoxemia and put them on bCPAP to examine its feasibility and acceptability by clinicians and parents. A total of 89 children were enrolled (49 from two tertiary and 40 from two general hospitals). Then qualitative data were collected through 75 repeated in-depth interviews by social-science experts with purposively selected 30 hospital health workers and 15 parents of 12 children who received bCPAP oxygen therapy in the hospitals. Interview data were supplemented by 6 observations in the hospitals. Data were analyzed using a thematic approach. Results Identified structural and functional challenges for the introduction of bCPAP in treating childhood severe pneumonia and hypoxemia in the study hospitals include: inadequate number of pulse oximeters; unavailability of nasal prongs with age-specific size; inadequate and non-functioning oxygen flow meters, concentrator, and cylinders; disruption in power-supply; and inadequate number of staff. The opportunities in introducing bCPAP oxygen therapy included the availability of a dedicated corner for the study patients situated in front of nurse’s station, required medicines and satisfactory level of clinicians’ knowledge and skills for treating severe pneumonia patients. Additionally, the identified operational challenges were occasional lack of bubbling in the water-filled plastic bottle, lack of stand for holding the water-filled plastic bottle, and delayed shifting of oxygen source from an oxygen concentrator to a cylinder, particularly during electricity disruption. Participants (clinicians and parents) expressed their satisfaction as bCPAP oxygen therapy was found to be simple to handle, children had ease of breathing and recovered fast without major ill effects. Conclusion Our study identified some important structural, functional, and operational challenges that need to be addressed before implementation of bCPAP oxygen therapy especially in frontline general hospitals with limited resources. In spite of these observed challenges, the clinicians and caregivers were highly satisfied with the overall performance of bCPAP oxygen therapy.

Almost all low-income countries and many middle-income countries lack the capacity to deliver medical genetics services. We developed the MiGene Family History App (MFHA), which assists doctors with family history collection and population-level epidemiologic analysis. The MFHA was studied at St. Paul’s Hospital in Addis Ababa, Ethiopia. A needs assessment was used to assess Ethiopian physicians’ experience with genetics services. The MFHA then collected patient data over a 6-month period. The majority of doctors provide genetics services, with only 16% reporting their genetics knowledge is sufficient. A total of 1699 patients from the pediatric ward (n = 367), neonatal intensive care unit (NICU) (n = 477), and antenatal clinic (n = 855) were collected using the MFHA with a 4% incidence of a MFHA-screened condition present. The incidence was 11.7% in the pediatric ward, 3% in the NICU, and 0.5% in the antenatal clinic. Heart malformations (5.5% of patients) and trisomy 21 (4.4% of patients) were the most common conditions in the pediatric ward. Medical genetics services are needed in Ethiopia. As other countries increase their genetics capacity, the MFHA can provide fundamental genetics services and collect necessary epidemiologic data.

Background: Nurses play critical roles as patient advocate, regulating quality of care and improve health care values. Data are scarce regarding quality of nursing care in Ethiopia. Objective: To assess quality of nursing care and convenience of the nurse working environment to provide quality of nursing care in a tertiary hospital in Ethiopia. Methods: Data was collected prospectively using Quality of Nursing Care Questionnaires of Safford & Schlotfeldt and Practice Environment Scale of Nursing Work Index (PES-NWI). One hundred seventeen nurses and 51 physicians were included and data was analyzed using SPSS for windows version-20. Result: Four of the five PES-NWI variables had mean score less than 2.5, suggesting the nursing environment and management was unfavorable to assure quality care. All nursing care performances were low. The highest score was in nurse carryout orders (66.7%) and lowest in nurse-physician collaboration (24.8%). Conclusion: The quality of nursing care is substandard. Favorable environment and nurse physician relationship must be established to provide quality care. Keywords: Quality-nursing care, Perception, Physician, Nurse work-environment, Ethiopia

BackgroundOver the past two decades non-communicable diseases (NCDs) have steadily increased as a cause of worldwide disability and mortality with a concomitant decrease in disease burden from communicable, maternal, neonatal and nutritional conditions. Congenital anomalies, the most common NCD affecting children, have recently become the fifth leading cause of under-five mortality worldwide, ahead of other conditions such as malaria, neonatal sepsis and malnutrition. Genetic counseling has been shown to be an effective method to decrease the impact of congenital anomalies and genetic conditions but is absent in almost all sub-Saharan Africa countries. To address this need for counseling services we designed and implemented the first broad-based genetic counseling curriculum in Ethiopia, launching it at St. Paul’s Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia.MethodsThe curriculum, created by Michigan Medicine and SPHMMC specialists, consisted of medical knowledge and genetic counseling content and was delivered to two cohorts of nurses. Curriculum evaluation consisted of satisfaction surveys and pre- and post-assessments covering medical knowledge and genetic counseling content. Following Cohort 1 training, the curriculum was modified to increase the medical knowledge material and decrease Western genetic counseling principles material.ResultsBoth cohorts reported high levels of satisfaction but felt the workshop was too short. No significant improvements in assessment scores were seen for Cohort 1 in terms of total scores and medical knowledge and genetic counseling-specific questions. Following curriculum modification, improvements were seen in Cohort 2 with an increase in total assessment scores from 63% to 73% (p = 0.043), with medical knowledge-specific questions increasing from 57% to 79% (p = 0.01) with no significant change in genetic counseling-specific scores. Multiple logistic, financial, cultural and systems-specific barriers were identified with recommendations for their consideration presented.ConclusionGenetics medical knowledge of Ethiopian nurses increased significantly following curriculum delivery though difficulty was encountered with Western genetic counseling material.

Background: Respiratory Syncytial Virus (RSV) is the commonest cause of lower respiratory tract infection (LRTI) in infants. However, the role of RSV in LRTI is unknown in Ethiopia. Objective: We aimed to determine the prevalence, seasonality and associated factors of RSV infection in previously healthy young infants with LRTI in Ethiopia. Methods: RSV antigen test was performed from nasopharyngeal swab of 117 young infants with symptoms of severe LRTIs. The first 10 eligible infants in each month from June 2018 to May 2019 were included in the study. Clinical, laboratory and imaging data were collected using a semi–structured questionnaire and data were analyzed using descriptive and analytical methods, chi-square test and logistic regression were applied as appropriate. Results: Majority of study subjects was male (65%) with median age of 3 months. Bronchiolitis was the commonest diagnosis (57%) followed by pneumonia and bronchitis. RSV was isolated from 26 (22.2%) of all infants and 37 % of those with bronchiolitis and 11 % of those with pneumonia. While RSV was observed to occur year round, the typical RSV season extended from June to November and only rainy season (Adjusted Odds Ratio 10.46 [95%.C.I. 1.95, 56.18]) was an independent predictor of RSV infection. Conclusion: RSV was isolated approximately in a fifth of infants, mostly in the rainy season. Lack of clinical, laboratory and imaging predictors of RSV infection emphasize the need of specific diagnostic tests for identification of the virus. As RSV is less common in our setting compared to other area, the other causes of LRTI should be investigated in future studies.

Isolated unilateral absence of the pulmonary artery is a rare anomaly with congenital absence of the left or right pulmonary artery in the absence of other cardiac malformation, and diagnosis is usually made during adolescence. We report a 4-year old male child with isolated absence of the right pulmonary artery, who presented with recurrent chest infection and wheezing since infancy.

Atnafu Mekonnen Tekleab,Yemisrach Mekonnen Asfaw,Abate Yeshidinber Weldetsadik,Gesit Metaferia Amaru Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia Background: Irrational use of antibiotics is a global problem. Failure to follow clinical guidelines is one of the main reasons for irrational use of antibiotics. Cough and/or diarrhea are the main childhood illnesses in Ethiopia, and health care providers are expected to follow the national guideline while managing these illnesses. This study tried to assess the extent of adherence to the guideline while managing cases of childhood diarrhea and/or cough.Methods: The study was conducted in 23 hospitals in Addis Ababa. Data were collected prospectively from April to June 2016 using a structured questionnaire. A total of 1,073 children aged 2–59 months who visited the hospitals for cough or diarrhea during the study period were included in the study. Equal number of cases were allocated to each hospital and consecutive cases were included in the study until the calculated sample size was attained for each hospital. Data collectors approached cases after they were seen by the health care provider. SPSS version 20 was used to analyze the data.Result: Of the total number of cases, an antibiotic was prescribed for 794 (74.0%) of the children. Cotrimoxazol 209 (26.3%), amoxicillin 185 (23.3%), and cephalosporines 174 (21.9%) were the three most commonly prescribed antibiotics. Six hundred eighty-eight (86.6%) of the prescriptions were determined to be inappropriate. Of the inappropriate prescriptions, 631 (91.7%) were for prescribing antibiotics when not necessary and 57 (8.3%) were for prescribing the wrong spectrum of antibiotics. Using multivariate analysis, a child not having diarrhea was independently associated with appropriate antibiotic prescription (adjusted odds ratio =0.261, 95% confidence interval: 0.095–0.714). The prescriber being qualified as a pediatrician was an independent predictor of inappropriate antibiotic prescription (adjusted odds ratio =9.967, 95% confidence interval: 4.221–23.532).Conclusion: The magnitude of inappropriate antibiotic prescription while managing cough and/or diarrhea in our setting was high. It needs urgent action to prevent emergence of antibiotic-resistant microorganisms. Keywords: diarrhea, cough, inappropriate antibiotic prescription, hospital, Addis Ababa

Retropharyngeal tuberculous abscess (RPTBA) is a rare manifestation of tuberculosis (TB) even in high TB burden areas. It rarely manifests as a cause of upper airway obstruction and obstructive sleep apnea (OSA) in children with few case reports in the literature. We report a 22 months old toddler who presented with upper airway obstruction and OSA and was diagnosed with RPTBA. The child recovered completely and growing normally after intra-oral aspiration and 6 months of anti-tuberculosis treatment.

Additional file 1. Key Informant Interview Guide Facility Leadership.doc, qualitative interview instrument.

Background Nursing care closely influences patients’ satisfaction with the overall quality of care, and the importance of measuring patient satisfaction with nursing care cannot be emphasized enough. Data are however scarce regarding patients’ perception of quality of nursing care in Ethiopia. We performed this study to assess patient’s perception of the quality of nursing care in a tertiary center in Ethiopia. Methods Data were collected prospectively using Quality of Nursing Care Questionnaires-patient of Safford & Schlotfeldt. A total of 340 patients were included using systematic random sampling and data were analyzed using SPSS for windows version- 20. Result The nursing care performance was highest for nurse-physician relation (mean = 3.95) and low for education and home care preparation and physical care (mean score of 2.79 and 2.89 respectively). The emotional care and nurse administration mean score were 3.5 and 3.83 respectively. The overall nursing quality was neither satisfying nor dissatisfying (mean of 3.39). While only 36% of the respondents were satisfied with the nursing care, patient education has the strongest (AOR of 7.4) association with satisfaction. Conclusion Patients perceived low quality of physical care, education and preparation for home care but better nurse-physician relation and nursing administration. However the overall quality measure was neither satisfying nor dissatisfying. This calls for an action from the health care administrators, educators and other stakeholders to improve the patient perception of quality nursing care.

Abate Yeshidinber Weldetsadik, Yemisrach Mekonnen Asfaw, Atnafu Mekonnen Tekleab Department of Pediatrics and Child Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia Abstract: Isolated unilateral absence of the pulmonary artery is a rare anomaly with congenital absence of the left or right pulmonary artery in the absence of other cardiac malformation, and diagnosis is usually made during adolescence. We report a 4-year old male child with isolated absence of the right pulmonary artery, who presented with recurrent chest infection and wheezing since infancy. Keywords: pulmonary artery, child, wheeze, chest infection, Ethiopia