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Zerihun Bogale,1 Yeweyenhareg Feleke2 1Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Endocrinology and Metabolism Unit, Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Zerihun Bogale, Tel +251-913-83-31-57, Email zerihunmed@gmail.comBackground: Rheumatoid arthritis (RA) is an a chronic inflammatory disease characterized by symmetric polyarticular inflammation that can lead to progressive joint damage. It is said to be rare among black Africans, even though there have been limited reports from some African countries and no study has been done on RA in Ethiopia. This study determined the prevalence, clinical features, and treatment of rheumatoid arthritis in Tikur Anbessa Specialized Hospital (TASH).Methods: A cross-sectional study design was conducted on diagnosed patients with RA attending the rheumatology clinic at TASH from November 2018 to February 2019. Data was collected through patient interviews and chart reviews. The dataset was subjected to descriptive statistical analysis using the Statistical Package for Social Sciences (SPSS) version 25.Results: A total of 1116 patients attended a rheumatologic clinic with rheumatologic complaints. The prevalence of rheumatoid arthritis was 18.5% (206/1116). Females were mostly affected (F:M 4.6:1). One hundred nineteen (57.8%) were between 35 and 64 years of age. The seropositivity for rheumatoid factor was 47.1%. Almost all patients had morning stiffness (89.8%) and joint pain (97.1%), with the majority (74.8%) having both small and large joint involvement. Nearly half of the patients, 99 (48.1%), had a joint deformity. Comorbid conditions seen in this study were hypertension (17%), overweight in 43 (20.9%), and obesity in 8 (3.9%). Methotrexate was the most prescribed agent (82.5%), both as monotherapy and along with other medications, but 139 (67.5%) of them were on prednisolone, which 2/3 (122) of patients took for 6 months in duration.Conclusion: RA accounted for nearly one-fifth of the patients coming to the rheumatology clinics, with females affected more, which is similar to reports from some African countries. Disease-modifying anti-rheumatic drugs are the most prescribed agents, but most patients are on a prolonged dose of prednisolone.Keywords: rheumatoid arthritis, rheumatology clinic, Tikur Anbessa Specialized Hospital, Ethiopia

ntroduction: Given the global prevalence of diabetes, diabetic nephropathy and its consequences are among the major causes of morbidity and mortality in diabetic populations. However, the prevalence and determinants of diabetic nephropathy in Ethiopia are little studied, and were the main objectives of this study. Methods: A cross-sectional study design was followed among 340 randomly selected diabetic patients attending the national diabetes referral clinics at the diabetes centre of Tikur Anbessa Specialized Hospital, Addis Ababa, using an interviewer-administered structured questionnaire. A total of 340 patients were involved, of whom 200 (59%) were females and 256 (75%) had type 2 diabetes mellitus. Urine and blood samples were drawn from the study population and the corresponding biochemical analyses were conducted at the Ethiopian Public Health Research Institute. Results: The mean age of the participants was 51.6 years (range 18–94 years). The median duration of their diabetes was 11 years (range 1–40 years). Forty-eight pecent of the patients were hypertensive. Only half of the hypertensive cases (53%) were using angiotensin-converting enzyme inhibitors, either alone or in combination with other antihypertensive medicines. Eighty-two percent of the participants had poorly controlled diabetes, with glycated haemoglobin >7%. None was using Sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide agonists. Some (109, 32%) of the participants were diagnosed with diabetic nephropathy in addition to reduced estimated glomerular filtration rate and albuminuria. Age, dyslipidaemia, educational status, presence of diabetic retinopathy, and elevated triglyceride levels were found to be significant predictors of the condition (P < 0.05). Conclusions: Diabetic nephropathy was present in nearly one-third of the diabetics in the study population. The management of diabetes with renoprotective agents, such as renin–angiotensin–aldosterone system inhibitors and SGLT2 inhibitors, are likely to be very important in this context. Keywords: diabetes mellitus, nephropathy, end-stage kidney disease, CKD

Background Vitamin D is essential for health and its shortage exacerbates overall mortality. Health care workers (HCWs) need to educate on its uses and sources although studies indicate their low level of practice. The main aim of this study is therefore to assess the knowledge, attitude and practice of measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs in Ethiopia. Methods This study was conducted in three ecologies covering lowland, midland and highland districts. A total of 405 health care workers with different levels were interviewed. Tablets were used for data collection to archiving in a cloud server. Data were exported to Stata version 14 software for cleaning and analysis. Rates were computed and the Chi-square test was used to compare differences between the two groups. Binary logistic regression was used to measure the strength, direction and significance of the association between different covariates and the practice of HCWs. Result The level of knowledge, positive attitude and good practice in measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs was 210 (51.8%), 261(63.5%) and 195(47.4%) respectively. The odds of good practice in the provision of adult vitamin D service were AOR = 6.87: 95% CI (3.57, 13.21) and AOR = 2.20: 95% CI (1.23, 3.92) times higher among HCWs in Addis Ababa and highlands compared with those working in lowlands. Good practice among clinicians was AOR = 4.26: 95% CI (1.48, 12.25) times higher compared with those working in leadership positions. The likelihood was AOR = 1.96: 95% CI (1.19, 3.23) times higher among those with good knowledge compared with those with poor knowledge. Besides, good practice in adult vitamin D service provision was AOR = 2.30: 95% CI (1.40, 3.78) times higher among those with positive attitude compared with those who had negative attitude. Conclusions A little over half of HCWs have good knowledge and close to two-thirds of them have positive attitude while less than half of them have good practice on adult vitamin D deficiency. Besides, HCWs’ residential ecology, clinical position, knowledge and attitude is associated with good practice on adult vitamin D. It is essential to provide rigorous and continuous training for HCWs focusing on their deployment ecology.

Background: Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.Methods: A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 hours of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as >140mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.Results: A total of 103 first-ever acute stroke patients were included (mean age = 55.5+15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10-19) compared to normoglycemic patients 11 (IQR 8-15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99-6.19) more likely to be functionally impaired (mRS = 3-5) at 30-days compared to normoglycemic patients (p = 0.041).Older age (≥ 65 years) (p = 0.017) and stroke severity (NIHSS >14) (p = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among the patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.Conclusions: Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-days of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

Background:- Although acute stroke accompanied by hyperglycemia is often associated with worse prognosis, the relationship between hyperglycemia and stroke outcome has not been studied in Ethiopian patients. As better understanding of this potentially adverse influence on stroke outcome would provide guidance for stroke management and acute care. This study aimed to determine frequency of admission hyperglycemia and its impact on thirty day functional outcome and case fatality among acute stroke patients in an urban setting in Ethiopia. Methods:- From July to December 2016, we collected information on 103 consecutive first ever acute stroke patients admitted within 72 hours of symptom onset to Tertiary hospital in Ethiopia. We obtained demographic, clinical and neuro-imaging data including capillary blood glucose at admission. National Institute of Health Stroke Scale and modified Rankin Scale were used to assess the baseline stroke severity and the degree of disability at thirty day. Results:- A total of 103 first ever acute stroke patients were enrolled with, mean age = 55.5+ 15.3 years, 64.1% male, 65% under the age of 65 years, and 31.1% were farmers by occupation . Fifty one (49.5%) patients had a documented hyperglycemia at admission with median National Institute of Health Stroke Scale score of 14 and 3(2.9%) of them were later diagnosed with diabetes mellitus. The mean modified Rankin score at 30-day was 3.6 + 1.45 while 34 (79.1%) of hyperglycemic stroke survivors scored between 3 and 5. Older age >65 years (p = 0.037), admission hyperglycemia (p = 0.04) and stroke severity (p

The prevalence of diabetes, dyslipidemias, and high blood pressure is increasing worldwide especially in low and middle income countries. World Health Organization has emphasized the importance of the assessment of the magnitude of the specific disease in each country. We determined the prevalence and determinant factors of high blood pressure, hyperglycemia, dyslipidemias and metabolic syndrome in Ethiopia. A community based survey was conducted from -April to June 2015 using WHO NCD STEPS instrument version 3.1. 2008. Multistage stratified systemic random sampling was used to select representative samples from 9 regions of the country. A total of 10,260 people aged 15–69 years participated in the study. Blood pressure (BP) was measured for 9788 individuals. A total of 9141 people underwent metabolic screening. The prevalence of raised blood pressure (SBP ≥140 and/or DBP ≥ 90 mmHg) was 15.8% (16.3% in females and 15.5% in males). The prevalence of diabetes mellitus (FBS ≥ 126 mg /dl) including those on medication was 3.2% (3.5% males and 3.0% females). The prevalence of impaired fasting glucose was 9.1% with ADA criteria and 3.8% with WHO criteria. Hypercholesterolemia was found in 5.2%, hypertriglyceridemia in 21.0%, high LDL cholesterol occurred in 14.1% and low HDL cholesterol occurred in 68.7%. The prevalence of metabolic syndrome using IDF definition was 4.8% (8.6% in females and vs. 1.8% in males). Advanced age, urban residence, lack of physical exercise, raised waist circumference, raised waist hip ratio, overweight or obesity, and total blood cholesterol were significantly associated with raised blood pressure (BP) and diabetes mellitus. Increased waist- hip ratio was an independent predictor of raised blood pressure, hyperglycemia and raised total cholesterol. Our study showed significantly high prevalence of raised blood pressure, hyperglycemia and dyslipidemia in Ethiopia. Community based interventions are recommended to control these risk factors.

Background: The major disorders of thyroid gland are hypothyroidism and hyperthyroidism and thyroid disorders are predominantly of autoimmune etiology in pregnant women. To date there is no study done in Ethiopia to show pattern and pregnancy outcomes of pregnant women with thyroid disorders. Objectives: To assess pattern of thyroid diseases, thyroid function test profiles, clinical presentations and pregnancy outcomes in pregnant women at National Endocrine Referral Clinics of Tikur Anbessa Specialized Hospital. Methods: A retrospective study was conducted at National Referral Endocrine Clinics of TASH from June 2010 to June 2015. All pregnant women with thyroid disorders were included in the study and patients’ charts were retrieved from follow up clinics and hospital archive by two trained residents of Internal medicine using pre-structured data collection tools. Results: Among a total of 1124 patients with endocrine disorders, 670 (59.6%) were patients with thyroid disorders and 9.25% (62) were pregnant women. Among pregnant women with thyroid disorders, majority, 51 (82.2%) were pregnant women with hyperthyroidism with mean (SD) age of 30 ± (6.45) years. Majority of patients with hyperthyroidism, 43(84.3%) were diagnosed to have TMNG followed by Graves’ disease. Among pregnant women with hypothyroidism, six were cases of iodine deficiency. The commonly seen symptoms of hyperthyroidism were, anterior neck swelling (94.1%), palpitation (47.1%) and heat intolerance (31.4%). Patients with hypothyroidism, accounted for 17.74% of thyroid diseases in pregnancy and the common symptoms were fatigue and cold intolerance each accounting for 9 (81.8%) of the cases. Most of pregnant women with hyperthyroidism, 37 (72.5%) gave birth to an alive neonate, 11 (21.6%) had abortion and the remaining 3 (5.9%) had IUFD. Conclusion: From our study, most of pregnant women with thyroid disorders were patients with hyperthyroidism. The pregnancy outcome of these patients was generally good. Recommendation: We recommend proper documentation and electronic medical recording to be practiced in the hospital and to have pre-pregnancy counseling for all reproductive age women who have follow up at endocrine referral clinics. We also recommend doing more comprehensive research on pregnancy outcomes of pregnant women with thyroid disorders and neonatal screening for congenital hypothyroidism.

Background: Hypoglycemia poses a barrier to optimum diabetes management especially among patients taking insulin therapy. However little is known about the magnitude and effect of hypoglycemia among diabetic patients in Ethiopia. Methods: A Cross-sectional study was conducted on diabetic patients who were above 14 years of age and attending National Diabetic referral clinic at Tikur Anbesa Specialized Hospital, between June and August 2016. Results: The study involved 562 diabetic patients (194 T1DM and 368 T2DM). Previous episode of hypoglycemia was experienced by 61.2% (344) of the patients. Hypoglycemia was reported by 88% T1DM and 69% of insulin treated T2DM .There were 523 episodes of hypoglycemia reported by 186(33.1%) of the patients in the last month, out of which 40(5.9%) episodes were sever hypoglycemia reported by 26 (14%) of the patients. Female gender, higher BMI, low educational status and higher FBS were associated with higher reported incident of previous hypoglycemia (p

Background Maximizing comprehension is a major challenge for informed consent processes in low-literacy and resource-limited settings. Application of rapid qualitative assessments to improve the informed consent process is increasingly considered useful. This study assessed the effects of Rapid Ethical Assessment (REA) on comprehension, retention and quality of the informed consent process. Methods A cluster randomized trial was conducted among participants of HPV sero-prevalence study in two districts of Northern Ethiopia, in 2013. A total of 300 study participants, 150 in the intervention and 150 in the control group, were included in the study. For the intervention group, the informed consent process was designed with further revisions based on REA findings. Informed consent comprehension levels and quality of the consent process were measured using the Modular Informed Consent Comprehension Assessment (MICCA) and Quality of Informed Consent (QuIC) process assessment tools, respectively. Result Study recruitment rates were 88.7 % and 80.7 % (p = 0.05), while study retention rates were 85.7 % and 70.3 % (p

Background: Diabetes mellitus (DM) affects connective tissues in many ways and causes different alterations in periarticular and skeletal systems. Methods: A cross-sectional study was conducted by interviewing and examining 402 consecutive diabetic patients followed at Tikur Anbessa Hospital OPD. Evaluation was performed according to the Short Musculoskeletal Function Assessment Questionnaire (SMFA). The diagnoses were established by Consultant Orthopedic Surgeon. Results: Average duration of diabetes is 143 months (12 Years) and majority, 66.7% (268/402) of them are currently on insulin therapy. Mean current FBS is 245mg%. Excluding OA (47, 11.7%) and CLBP (78, 19.4%), overall prevalence of 1 or more of musculoskeletal Diseases (MSD) is 41.5 %. Hands were the most affected (74, 18.5 %). Five had amputation. Hand involvement and sex of the patient and Type of diabetes is significantly associated, Duration of DM and shoulder involvement are significantly related. Conclusions: Musculoskeletal manifestations are very high in adult diabetic patients at the centre and need multidisciplinary clinical attention. Physicians should always consider examining the periarticular regions of the joints in the hands and feet. Duration of diabetes is associated with development of shoulder complications. Recommendations: Routine MSD screening, establishing a foot care clinic and strengthening diabetic education may prevent development or worsening of MSD. https://dx.doi.org/10.4314/ecajs.v22i2.6 This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.

Standard information sheet and Consent form for â HPV-Subtype Prevalence Studyâ . This version is the non-modified information sheet and consent form, the version initially approved by the IRB. This is the very version of information sheet and consent form administered used the control group. (DOCX 17 kb)

Data collection materials used for comprehension assessment in "HPV-subtypes Prevalence Study". These are the data collection material used for testing comprehension and quality of informed consent in both the control and intervention groups. The material were developed based on Modular Informed Consent Comprehension Assessment (MICCA), Brief Investigator Questionnaire (BIQ) and Quality of Informed Consent (QuIC) tools. (DOCX 28 kb)

Modified information sheet and consent form for ''HPV-Subtype Prevalence Study''. This is the modified version of information sheet and consent form administered for the intervention group. Modifications were done on the IRB approved version based on the REA (Rapid Ethical Assessment) conducted prior recruitment. (DOCX 21 kb)

Background: Rapid Ethical Assessment (REA) is a form of rapid ethnographic assessment conducted at the beginning of research project to guide the consent process with the objective of reconciling universal ethical guidance with specific research contexts. The current study is conducted to assess the perceived relevance of introducing REA as a mainstream tool in Ethiopia.\ud \ud Methods: Mixed methods research using a sequential explanatory approach was conducted from July to September 2012, including 241 cross-sectional, self-administered and 19 qualitative, in-depth interviews among health researchers and regulators including ethics committee members in Ethiopian health research institutions and universities.\ud \ud Results: In their evaluation of the consent process, only 40.2% thought that the consent process and information given were adequately understood by study participants; 84.6% claimed they were not satisfied with the current consent process and 85.5% thought the best interests of study participants were not adequately considered. Commonly mentioned consent-related problems included lack of clarity (48.1%), inadequate information (34%), language barriers (28.2%), cultural differences (27.4%), undue expectations (26.6%) and power imbalances (20.7%). About 95.4% believed that consent should be contextualized to the study setting and 39.4% thought REA would be an appropriate approach to improve the perceived problems. Qualitative findings helped to further explore the gaps identified in the quantitative findings and to map-out concerns related to the current research consent process in Ethiopia. Suggestions included, conducting REA during the pre-test (pilot) phase of studies when applicable. The need for clear guidance for researchers on issues such as when and how to apply the REA tools was stressed.\ud \ud Conclusion: The study findings clearly indicated that there are perceived to be correctable gaps in the consent process of medical research in Ethiopia. REA is considered relevant by researchers and stakeholders to address these gaps. Exploring further the feasibility and applicability of REA is recommended.

Background: Insulin resistance, which precedes by many years the onset of and accompanies type II diabetes (T2D), is strongly associated with a clustering of cardiovascular risk factors, termed metabolic syndrome (MetS). Objectives: The aim of this study was to investigate the extent of MetS risk in T2D Ethiopian patients. Methods: A total of 72 T2D patients and 20 normal healthy controls without MetS were studied. Based on the world health organization criteria, 59.72% (43/72) of the patients had MetS. Results: Type 2 diabetic patients with MetS (0.953 ± 0.007) were significantly (P

Background: HIV patients have several habits that can produce oral lesions. However the association of oral habits and risk behaviors with oral and peri-oral lesions in HIV patients has not been studied in Ethiopia to date. Objective: To assess the relationship of oral and peri-oral lesions with oral habits risk behaviors socio-demographic factors and clinical stages of disease among HIV infected adult Ethiopians. Methodology A cross-sectional study was conducted on consecutive adult ART naive HIV patients at ART clinic of Tikur Anbessa Specialized University Hospital Addis Ababa Ethiopia during December 2005 to July 2006. The EC-clearing houses classification and diagnostic criteria for oral lesions in HIV infection was used. Written informed consent was obtained before enrollment to the study. Results A total of 384 patients 126 (33%) males and 258 (67%) females were evaluated. The mean + SD age of males was 39.9 +10.56 and females was 33.17 + 8.85 years. Fifty seven (15%) of the unit of analysis were smokers 178 (46%) alcohol consumers and 217(57.1%) khat chewers use tooth sticks for dental cleaning. Of which 132 (34.7%) clean their teeth at least once a day and 302 (79%) gave history of recent significant weight loss. Linear regression analysis showed association of oral and peri-oral lesions with less frequent cleaning (p=0.038 p=0.03 respectively) means of cleaning (p=0.004; p=0.001) broad-spectrum antibiotic use (p=0.019 p=0.008) advanced stage of HIV (p=0.016 p=0.001) and CD4 level below 200 Cells/mm3 (p=0.001 p=0.01). The oral lesions were seen more frequently among smokers (p=0.028) heavy alcohol consumers (p=0.041) those with age above 40 years (p=0.016) and recent weight loss (p=0.001). At the level of binary logistic regression analysis smoking (p=0.005) CD4 count less than 200 (p=0.039) and stage 3 (p=0.022) and stage 4 disease (p=0.046) were found to be independent risks while daily dental cleaning habit was found to be protective (p=0.021). Conclusion Oral and peri-oral diseases among HIV/AIDS patients and are significantly associated with correctable risk factors like smoking and poor oral cleaning habits. Lesions are also frequent with evidence of advanced HIV disease and low CD4 count. These findings demonstrate the need for oral health examination and education to improve on risk behaviors and oral care in HIV/AIDS patients.

Background : During the past decade, diabetes mellitus has emerged as an important clinical and public health problem through out the world. WHO estimated the number of cases of diabetics in Ethiopia to be about 800,000 in 2000, and projected that it would increase to about 1.8 million by the year 2030. Care for diabetic patients may require close and sustained support from a health care team, adequate financial resources, and advanced patient knowledge and motivation. In this respect, there is lack of information in the country. Objective : This study was conducted with the aim of assessing the characteristics of the health care system for diabetic patients, how diabetic patients are cared for including medical care and adequacy of facilities for the prevention of complications and outcomes at primary health care and secondary health care levels. Methods : An assessment of the characteristics of the health care system (structure) for diabetic patients was conducted in 21 health centres (primary health care level) and 5 regional hospitals (secondary health care level) in Addis Ababa. Furthermore, a total of 106 diabetic patients drawn from six out of the 21 health centres and another 123 diabetic patients drawn from three of the six hospitals were consecutively interviewed. Results : All the Regional hospitals and one of the health centres were running established diabetic referral clinics. Similarly, a lack of professionals was observed in all the health institutions in general and the health centres, in particular. Only 21% of patients had access for blood glucose monitoring at the same health institutions. The emphasis given for diabetic education (24%) was less than expected. Only 11 (5%) of diabetic patients were able to do self blood glucose monitoring at home. Fifty one percents of patients didn't have urine analysis, BUN, creatinine and lipid profile in the previous 1-2 years. None of diabetic patients had haemoglobin Alc (HbA1c) determination. Nearly 75% of the patients required admissions directly or indirectly due to uncontrolled diabetes. About 87% of the diabetics had regular follow ups at their respective health centres and hospitals. Hypertension (34%), diabetes related eye disease (33%) and renal disease (21%) were the major associated illnesses observed among the diabetics. Sixty-six patients (23%) had a total of about 131 admissions. Conclusion : Although there is a well-established health infrastructure for diabetics care in Addis Ababa, the diabetic care is below the acceptable standard. The finding of this study may, thus, help to clarify issues related to potential changes in the health care system dealing with diabetes and for strengthening the referral system for diabetes health care. Ethiopian Journal of Health Development Vol. 19(3) 2005: 203-210