The impact of the COVID-19 pandemic on international reconstructive collaborations in Africa

Background
The SARS-CoV-2 (COVID-19) pandemic has catalysed a widespread humanitarian crisis in many low- and middle-income countries around the world, with many African nations significantly impacted. The aim of this study was to quantify the impact of the COVID-19 pandemic on the planning and provision of international reconstructive collaborations in Africa.

Methods
An anonymous, 14-question, multiple choice questionnaire was sent to 27 non-governmental organisations who regularly perform reconstructive surgery in Africa. The survey was open to responses for four weeks, closing on the 7th of March 2021. A single reminder was sent out at 2 weeks. The survey covered four key domains: (1) NGO demographics; (2) the impact of COVID-19 on patient follow-up; (3) barriers to the safe provision of international surgical collaborations during COVID-19; (4) the impact of COVID-19 on NGO funding.

Results
A total of ten reconstructive NGOs completed the survey (response rate, 37%). Ethiopia (n = 5) and Tanzania (n = 4) were the countries where most collaborations took place. Plastic, reconstructive and burns surgery was the most common sub-speciality (n = 7). For NGOs that did not have a year-round presence in country (n = 8), only one NGO was able to perform reconstructive surgery in Africa during the pandemic. The most common barrier identified was travel restrictions (within country, n = 8 or country entry-exit, n = 7). Pre-pandemic, 1547 to ≥ 1800 patients received reconstructive surgery on international surgical collaborations. After the outbreak, 70% of NGOs surveyed had treated no patients, with approximately 1405 to ≥ 1640 patients left untreated over the last year.

Conclusions
The COVID-19 pandemic has placed huge pressures on health services and their delivery across the globe. This theme has extended into international surgical collaborations leading to increased unmet surgical needs in low- and middle-income countries.

Late Diagnosis of Breast Cancer and Associated Factors Among Women Attending Hawassa University Comprehensive and Specialized Hospital Southern Ethiopia

Background; Breast cancer is a significant public health issue in sub-Saharan Africa and the second commonest cancer overall. In Ethiopia, most women present at the late-stage presentation. This is because Ethiopian government gives less attention, and is not well-studied as well. Therefore, it is important to assess delays in diagnosis and treating breast cancer that has been associated with a more advanced stage of the disease and a decrease in patient survival rates.

Objective: To assess the magnitude and associated factors for late diagnosis of breast cancer among women attending Hawassa University Comprehensive Specialized Hospital in Southern Ethiopia.

Methodology: A facility-based cross-sectional study was conducted from December to January 2019. Data were collected from 261 consecutively selected clients based on the arrival of their hospital visit by using a pretested structured questionnaire and checklist. Physicians performed physical examinations and diagnoses. Data was checked for completeness and consistency, and entered into epi data, then exported to SPSS for analysis. Descriptive, Bivariate, and multivariable logistic regression analyses were performed using SPSS Version 25 Statistical Software.

Results: The magnitude of late diagnosis of breast cancer was 86.3%. The woman who had no initial advice for breast biopsy [AOR=5.1, 95% (CI=1.4-18.9)], not sharing the problem to others [AOR=4.7, 95% (CI=1.8-12.2)] and using traditional and faith healers as a first treatment choice [AOR=3.3, 95% (CI=1.2 – 8.8)] were associated with late diagnosis of breast cancer.

Conclusions: The majority of women having breast cancer were diagnosed at a late stage. It needs attention to provide better options of the modern health service, and providing accessible initial advice for breast biopsy, and creating awareness about the benefit of sharing problems with family to improve the health of mothers by early diagnosing and managing the breast cancer.

Evaluation of Surgical Glove Integrity: Does an African Country Receive Inferior Quality?

In a 2017 study, the incidence of glove perforation in Addis Ababa was found higher than most other publications. This poses a significant threat to both patients and the surgical workforce. We hypothesized that poor surgical glove quality may have contributed to the high incidence. Hence, we tested the integrity of six brands of sterile gloves. The assumption was the perforation rate in these gloves would be higher than the standard acceptable quality level (AQL).

From the 1,200 single gloves evaluated, 59 (4.9%) gloves had perforations. Brand 1 (13.5%) and Brand 5 (10%) had the highest rate of perforations, followed by Brand 3 (3.0%) Brand 6 (2.0%), Brand 2 (1.0%) and Brand 4, which had 0 perforations. Compared to the standard AQL 1.5 for surgical gloves at the time of the study, Brand 1 and Brand 5 had a significantly higher perforation rate (13.5%, CI=8.8%-18.2%, p=0.000) and (10.0%, CI=5.8%-14.2%, p=0.000), respectively.

Our study results showed unacceptably high rates of perforation for 2 glove brands. The implications of this are staggering for surgical staff. In Ethiopia, choice of surgical glove brand may be a determinant of surgical safety.

In view of our findings of a large proportion of glove perforations prior to use, we recommend, at minimum, that surgeons visually inspect gloves before and after donning. Relevant government institutions, contractors, importers, hospital administrators, and surgical teams must take collective responsibility for ensuring appropriate quality of gloves. Quality enforcement must be strengthened, and local production must be considered.

The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia

The World Health Organization (WHO) recently put forth a Global Strategy on Digital Health 2020–2025 with several countries having already achieved key milestones. We aimed to understand whether and how digital health technologies (DHTs) are absorbed in Africa, tracking Ethiopia as a key node. We conducted a systematic review, searching PubMed-MEDLINE, Embase, ScienceDirect, African Journals Online, Cochrane Central Registry of Controlled Trials, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform databases from inception to 02 February 2021 for studies of any design that investigated the potential of DHTs in clinical or public health practices in Ethiopia. This review was registered with PROSPERO (CRD42021240645) and it was designed to inform our ongoing DHT-enabled randomized controlled trial (RCT) (ClinicalTrials.gov ID: NCT04216420). We found 27,493 potentially relevant citations, among which 52 studies met the inclusion criteria, comprising a total of 596,128 patients, healthy individuals, and healthcare professionals. The studies involved six DHTs: mHealth (29 studies, 574,649 participants); electronic health records (13 studies, 4534 participants); telemedicine (4 studies, 465 participants); cloud-based application (2 studies, 2382 participants); information communication technology (3 studies, 681 participants), and artificial intelligence (1 study, 13,417 participants). The studies targeted six health conditions: maternal and child health (15), infectious diseases (14), non-communicable diseases (3), dermatitis (1), surgery (4), and general health conditions (15). The outcomes of interest were feasibility, usability, willingness or readiness, effectiveness, quality improvement, and knowledge or attitude toward DHTs. Five studies involved RCTs. The analysis showed that although DHTs are a relatively recent phenomenon in Ethiopia, their potential harnessing clinical and public health practices are highly visible. Their adoption and implementation in full capacity require more training, access to better devices such as smartphones, and infrastructure. DHTs hold much promise tackling major clinical and public health backlogs and strengthening the healthcare ecosystem in Ethiopia. More RCTs are needed on emerging DHTs including artificial intelligence, big data, cloud, cybersecurity, telemedicine, and wearable devices to provide robust evidence of their potential use in such settings and to materialize the WHO’s Global Strategy on Digital Health.

Data on histological characteristics, survival patterns and determinants of mortality among colorectal, esophageal and prostate cancer patients in Ethiopia

This article describes data collected retrospectively on a cohort of esophageal, colorectal and prostate cancer patients registered in the patient log book of Tikur Anbessa Specialized Hospital, Ethiopia, from January 1, 2012 to December 31, 2017. The key variables studied include histological characteristics of each type of cancer, clinical and TNM stages, baseline laboratory results (Carcinoembryonic antigen (CEA) for colorectal cancer, Prostate-Specific Antigen (PSA) for prostate cancer, hemoglobin level, etc.), clinical characteristics including sign and symptoms, family history of cancer, diagnostic and treatment modalities a patient received for each type of cancer. The event status (death) was also collected using death certificates (whenever available) and supplemented by telephone interviews with the patient or attendant. Furthermore, lifestyle characteristics of patients including tobacco use, alcohol consumption, khat (‘Catha edulis’) chewing, etc. and socioeconomic characteristics including age, sex, region of residence, marital status, and educational level were also collected. The aim that led to conduct the study that generated these data was to describe clinical presentation, histological characteristics, survival pattern, and to identify determinants of mortality among cancer patients in Ethiopia. Thus, independent survival analyzes were performed using Kaplan-Meier estimates and life table analysis. Furthermore, Cox’s proportional hazards regression was developed to investigate the survival pattern and determinants of cancer specific mortality among colorectal, esophageal and prostate cancer patients.

Evaluating the effect of interventions for strengthening non-physician anesthetists’ education in Ethiopia: a pre- and post-evaluation study

Background
Access to safe surgery has been recognized as an indispensable component of universal health coverage. A competent anesthesia workforce is a prerequisite for safe surgical care. In Ethiopia, non-physician anesthetists are the main anesthesia service providers. The Government of Ethiopia implemented a program intervention to improve the quality of non-physician anesthetists’ education, which included faculty development, curricula strengthening, student support, educational resources, improved infrastructure and upgraded regulations. This study aimed to assess changes following the implementation of this program.

Methods
A pre-and post-evaluation design was employed to evaluate improvement in the quality of non-physician anesthetists’ education. A 10-station objective structured clinical examination (OSCE) was administered to graduating class anesthetists of 2016 (n = 104) to assess changes in competence from a baseline study performed in 2013 (n = 122). Moreover, a self-administered questionnaire was used to collect data on students’ perceptions of the learning environment.

Results
The overall competence score of 2016 graduates was significantly higher than the 2013 class (65.7% vs. 61.5%, mean score difference = 4.2, 95% CI = 1.24–7.22, p < 0.05). Although we found increases in competence scores for 6 out of 10 stations, the improvement was statistically significant for three tasks only (pre-operative assessment, postoperative complication, and anesthesia machine check). Moreover, the competence score in neonatal resuscitation declined significantly from baseline (from 74.4 to 68.9%, mean score difference = − 5.5, 95% CI = -10.5 to − 0.5, p  0.05 in favor of females), and female students scored better in some stations. Student perceptions of the learning environment improved significantly for almost all items, with the largest percentage point increase in the availability of instructors from 38.5 to 70.2% (OR = 3.76, 95% CI = 2.15–6.55, p < 0.05).

Conclusion
The results suggest that the quality of non-physician anesthetists’ education has improved. Stagnation in competence scores of some stations and student perceptions of the simulated learning environment require specific attention.

Magnitude of undernutrition and associated factors among children with cardiac disease at University of Gondar hospital, Ethiopia

Background
Undernutrition and cardiac disease are interconnected in a vicious cycle. Little is known about the effect of undernutrition on cardiac disease among children in low- and middle-income countries (LMICs). This study aimed to assess magnitude of undernutrition and associated factors among children with cardiac disease at University of Gondar hospital, northwest Ethiopia.

Method
This hospital-based cross-sectional study included children with cardiac disease presenting to the pediatric outpatient clinic at University of Gondar Hospital, Ethiopia. A self-administered questionnaire was administered to participating families, and medical records were reviewed. All participants who fulfill the inclusion criteria were included. Anthropometric measurements were made and the presence of malnutrition was diagnosed according to the WHO criteria. Associated factors of undernutrition analyzed by using binary logistic regression model. Variables with p-value ≤0.2 in bivariate analysis were fitted to the final multivariable analysis and those variables with p-value ≤0.05 were considered as having statistically significant association to the outcome variable. AOR and 95% confidence interval was calculated to assess the strength of association between the variables.

Result
A total of 269 patients participated in the study. 177 (65.7%) were undernourished, of whom 96 (54.5%) were underweight, 70 (39.7%) were stunted, and 95 (53.9%) were wasted. Pulmonary hypertension (adjusted odds ratio [AOR] = 3.82, 95%CI 1.80–8.10), NYHA/modified Ross class III and IV heart failure (AOR = 4.64, 1.69–12.72) and cardiac chamber enlargement (AOR = 2.91, 1.45–5.66) were associated with undernutrition.

Conclusion
Undernutrition is common among children with cardiac disease in northern Ethiopia. Children with pulmonary hypertension, high-grade heart failure, and cardiac chamber enlargement may warrant close follow-up for malnutrition.

Level of knowledge and practice of female healthcare providers about early detection methods of breast cancer at Debre Tabor Comprehensive Specialised Hospital: a cross-sectional study

Background: Despite the higher mortality rate of breast cancer in low and middle-income countries, the practice of early detection methods is low and the majority of the patients presenting at an advanced stage of the disease need palliative care with low survival rates. Although healthcare providers are the key for practicing early detection methods of breast cancer for themselves and their clients, little is known about their knowledge and practice of early detection methods of breast cancer in Northcentral Ethiopia.

Methods: An institution-based cross-sectional study was conducted among female healthcare providers at Debre Tabor Comprehensive Specialised Hospital. Data were collected using a structured self-administered questionnaire. The data were analysed using SPSS version 23. Descriptive statistics were used to describe the socio-demographic information of participants. Binary and multivariable logistic regression with adjusted odds ratio (AOR) and 95% confidence interval (CI) was used to identify factors associated with the outcome variable. Statistical significance was declared at p 2 years (AOR = 3.2; 95% CI: 1.72, 5.29), history of any breast problem (AOR = 1.4; 95% CI: 1.02, 2.37), family history of breast cancer (AOR = 4.0; 95% CI: 2.58, 15.84), having good knowledge (AOR = 2.9; 95% CI: 1.3, 6.52) and history of comorbidities (AOR = 1.09; 95% CI: 1.09, 3.59) were the factors associated with the practice of breast self-examination.

Conclusion: Our study found that the knowledge and practice of breast cancer early detection methods was low in the study setting. Only less than half of female healthcare providers practiced regular breast self-examination, which suggests the need to provide training for healthcare providers to fill the gap and to promote early detection of breast cancer cases.

Magnitude, Factors Associated with Cesarean Delivery and Its Appropriateness

Inappropriate use of CS can have profoundly negative consequences for women and the broader community. A recent meeting of the International Confederation of Midwifes, the International Federation of Gynecologists and Obstetrics and the Gates Foundation to discuss the impact of rising CS rates on maternal and infant mortality in LMICs highlights the international importance of the issue. Knowledge of CS determinants is a first step in the effort to define strategies to reduce unnecessary CSs. Previous studies showed that the main reasons for performing CS are clinical factors. However, non-clinical factors such as demographic, health system factors, organizational variables were overlooked determinants that best predicted which women have a higher risk of CS.

Surgical management and outcomes of late-presenting acute limb ischaemia at 2 referral hospitals in Addis Ababa, Ethiopia: A 1-year prospective study

Objective: The study was performed to show the overall perspective of surgical management for acute limb ischemia specific to Ethiopian population.
Methods: A prospective planned cohort study was conducted to analyze the socio-demography, clinical presentation, causes of limb ischemia, and outcomes of surgical intervention, and variables associated with complications of acute limb ischemia.
Results:A total of 102 patients were operated upon. The male to female ratio was 2:1; the mean age of presentation was 54±17 years. Patients presented after an average of 9±4.8 days of symptom onset. The type of procedures performed were, thrombectomy 51(47.2%), primary amputation 24(22.2%), bypass or interposition vascular grafts 10(9.2%), embolectomy 10(9.2%), primary vascular repair 7(6.4%), and femoro-femoral graft 6(5.5%). Local and systemic complications occurred in 35.3% and 17.6% respectively. Amputation after re-vascularization surgery was seen in 32.4%. A 30-day total amputation & mortality rate was 52.9% and 9.8% respectively. Clinical variables found to have a statistical significant association (P<0.05) with complications were age ≥ 60 years, late presentation (≥ 9days), patients with hypertensive disease and previous myocardial infarction.
Conclusions: Optimizing co-morbidities, timely detection and treating immediately on arrival could potentially play a key role in improving surgical outcomes of acute limb ischemia.