One Health Approach and Antimicrobial Resistance: From Global to Ethiopian Context

Recently, antimicrobial resistance is considered as a global health crisis. Some are thought that we are now in post-antibiotic era. Despite data gaps are largest; it creates particularly significant intimidation to low- and middle-income countries. Many factors are responsible for the development of resistance to antimicrobials by microorganisms. Weak regulations and usage inaccuracies are the major causes for the occurrence of antibiotic resistance. In the last three decades, greater than thirty new infectious diseases, most originated from animals, have been emerged. There is also rising of antimicrobial consumption across the world. The growth
of human populations and an increase in contact with wildlife contribute to the spread of resistance and making it a global health concern. Since there are many routes by which drug metabolites and resistant microbes can disseminate among humans, animals and the environment, One Health Approach is urgently required to address antimicrobial resistance in global, national and local level, including Ethiopia. Internationally, the worst threat comes from the emergence and rapid spread of multi-drug resistant Gramnegative bacteria. Once again, an intercontinental, interdisciplinary and multiple approaches should be taken to combat this problem among worldwide nations with special emphasis in developing countries encompassing Africa and Ethiopia.

Predictors of prolonged length of hospital stay and in-hospital mortality among adult patients admitted at the surgical ward of Jimma University medical center, Ethiopia: prospective observational study

Background
Data regarding prolonged length of hospital stay (PLOS) and in-hospital mortality are paramount to evaluate efficiency and quality of surgical care as well as for rational resource utilization, allocation, and administration. Thus, PLOS and in-hospital mortality have been used as a surrogate indicator of satisfactory treatment outcome and efficient utilization of resources for a given health institution. However, there was a scarcity of data regarding these issues in Ethiopia. Therefore, this study aimed to assess treatment outcome, length of hospital stay, in-hospital mortality, and their determinants.

Methods
Health facility-based prospective observational study was used for three consecutive months among adult patients hospitalized for the surgical case. Socio-demographic, clinical history, medication history, in-hospital complications, and overall treatment outcomes were collected from the medical charts’ of the patients, using a checklist from the day of admission to discharge. PLOS is defined as hospital stay > 75th percentile (≥33 days for the current study). To identify predictor variables for both PLOS and in-hospital mortality, multivariate logistic regression was performed at p-value  2 antibiotic exposure (p  7 days (p < 0.0001) were independent predictors for PLOS.

Conclusion
In-hospital mortality rate was almost comparable to reports from developing countries, though it was higher than the developed countries. However, the length of hospital stay was extremely higher than that of reports from other parts of the world. Besides, different socio-demographic, health facility’s and patients’ clinical conditions (baseline and in-hospital complications) were identified as independent predictors for both in-hospital mortality and PLOS. Therefore, the clinician and stakeholders have to emphasize to avoid the modifiable factors to reduce in-hospital mortality and PLOS in the study area; to improve the quality of surgical care.

A traveling fellowship to build surgical capacity in Ethiopia: the Jimma University specialized hospital and operation smile partnership

A lack of trained providers is an important contributor to the unmet burden of surgical disease treatment in low- and middle-income countries. The World Health Organization’s Commission on the International Recruitment of Health Personnel lays out guiding principles for addressing this workforce crisis. However, for surgical subspecialties such as plastic surgery, in-country training opportunities remain limited and there is a clear need for effective strategies to retain providers and develop sustainable solutions. We report the design and early implementation of a traveling fellowship in plastic surgery for providers at Jimma University Specialized Hospital in Jimma, Ethiopia. This fellowship is supported by Operation Smile and its network of international surgical volunteers. Since its inception, the program has trained 2 general surgeons with a commitment to helping train a total of 6 surgeons to establish a self-sustaining service. Key innovations include multiple international sites to facilitate broad subspecialty training, commitment of participants to return to Jimma upon completion of the program to establish a local training service, and coordination with national governing bodies to ensure program recognition and support. Ongoing challenges include physical resource limitations and coordination with a wide array of stakeholders. Nongovernmental organizations also have a role to play in supporting the Ministries of Health in scaling up human resources for improved health within their countries. Operation Smile’s traveling fellowship demonstrates a feasible method of addressing the health workforce crisis by providing specialized training and facilitating the development of surgical teaching programs capable of sustainably serving local communities.

Clinical profile and patterns of extremity fractures among patients visiting orthopedics department in Tikur Anbessa specialized hospital, Ethiopia.

Background: Fracture is a loss in the structural continuity of bone which results from injury, repetitive stress, or abnormal weakening of the bone. Globally, fracture injury continues to be an important cause of morbidity and disability both in the developed and developing countries.

Objective: The aim of this study was to assess the clinical profile and patterns of extremity fracture patients visiting orthopedic department at TASH, Ethiopia.

Materials and Method: Institutional based retrospective cross-sectional study was carried out. The sample size was 354 and study participants were extermity fracture cases. The data were analyzed using SPSS 21. Chi-square (χ2) test was applied to see if there was any association between the different variables.

Results: Most of the fracture victims, 111 (32.6%), were between the ages of 15 and 29 years. Lower extremity fracture (65.6%) was more common compared to upper extremity (34.7%). The femur (23.7 %) was the commonest fractured bone. The common patterns of fractures were transverse type which accounted for (35.5 %). The leading causes of fractures were road traffic injuries (RTIs) (42.2%) followed by falling down accidents (29.6%). The Cause of fracture and number of bone fracture were significantly associated with age (p<0.05).

Conclusion: The most commonly fractured bone in the extremities was the femur followed by tibia and fibula. Transverse factures followed by communited-type of fractures were the commonest patterns of fracture. The leading cause of fracture was road traffic injury followed by falling-down accidents.

Incidence and factors associated with postoperative nausea and vomiting among elective adult surgical patients at University of Gondar comprehensive specialized hospital, Northwest Ethiopia, 2019: A cross-sectional study

Background
Postoperative nausea and vomiting is a common complication of anaesthesia and surgery. It is considered the most common cause of morbidity following anaesthesia and has significant effects on patient satisfaction and cost. Despite modern anaesthetic and surgical techniques, the incidence of PONV remains high.

Objective
The objective of this study was to determine the incidence of postoperative nausea and vomiting and associated factors.

Methods
A cross-sectional study was conducted from January 1 to May 30, 2019. A total of 355 adult elective patients who were operated on this period were included in the study.

Results
The incidence of postoperative nausea and vomiting was 17.2% within 24 h after operation. Factors that were associated with postoperative nausea and vomiting were history of motion sickness (AOR = 6.0, CI = 2.51–14.49), previous history of postoperative nausea and vomiting (AOR = 13.55, CI = 6.37–28.81) and long duration of surgery (AOR = 10.1, CI = 3.97–25.92).

Conclusion
and recommendations: The incidence of postoperative nausea and vomiting was still high compared with most studies conducted in the world. However, when it compared to the previous study done in the study area, it showed significant reduction in the incidence of PONV by 19%.We suggest that the use of anti-emetic prophylaxis and the introduction of postoperative nausea and vomiting treatment protocols

Severe maternal outcomes in eastern Ethiopia: Application of the adapted maternal near miss tool.

BACKGROUND:
With the reduction of maternal mortality, maternal near miss (MNM) has been used as a complementary indicator of maternal health. The objective of this study was to assess the frequency of MNM in eastern Ethiopia using an adapted sub-Saharan Africa MNM tool and compare its applicability with the original WHO MNM tool.

METHODS:
We applied the sub-Saharan Africa and WHO MNM criteria to 1054 women admitted with potentially life-threatening conditions (including 28 deaths) in Hiwot Fana Specialized University Hospital and Jugel Hospital between January 2016 and April 2017. Discharge records were examined to identify deaths or women who developed MNM according to the sub-Saharan or WHO criteria. We calculated and compared MNM and severe maternal outcome ratios. Mortality index (ratio of maternal deaths to SMO) was calculated as indicator of quality of care.

RESULTS:
The sub-Saharan Africa criteria identified 594 cases of MNM and all the 28 deaths while the WHO criteria identified 128 cases of MNM and 26 deaths. There were 7404 livebirths during the same period. This gives MNM ratios of 80 versus 17 per 1000 live births for the adapted and original WHO criteria. Mortality index was 4.5% and 16.9% in the adapted and WHO criteria respectively. The major difference between the two criteria can be attributed to eclampsia, sepsis and differences in the threshold for transfusion of blood.

CONCLUSION:
The sub-Saharan Africa criteria identified all the MNM cases identified by the WHO criteria and all the maternal deaths. Applying the WHO criteria alone will cause under reporting of MNM cases (including maternal deaths) in this low-resource setting. The mortality index of 4.5% among women who fulfilled the adapted MNM criteria justifies labeling these women as having ‘life-threatening conditions’.

The lucky ones get cured: Health care seeking among women with pelvic organ prolapse in Amhara Region, Ethiopia.

Abstract
BACKGROUND:
The majority of women suffering from maternal morbidities live in resource-constrained settings with diverse barriers preventing access to quality biomedical health care services. This study aims to highlight the dynamics between the public health system and alternative healing through an exploration of the experiences of health care seeking among women living with severe symptomatic pelvic organ prolapse in an impoverished setting.

METHODS:
The data were collected through ethnographic fieldwork at the hospital and community levels in the Amhara region of Ethiopia. The fieldwork included participant observation, 42 semi-structured interviews and two focus group discussions over a period of one year. A group of 24 women with severe symptomatic pelvic organ prolapse served as the study’s main informants. Other central groups of informants included health care providers, local healers and actors from the health authorities and non-governmental organisations.

RESULTS:
Three case stories were chosen to illustrate the key findings related to health care seeking among the informants. The women strove to find remedies for their aggravating ailment, and many navigated between and combined various available healing options both within and beyond the health care sector. Their choices were strongly influenced by poverty, by lack of knowledge about the condition, by their religious and spiritual beliefs and by the shame and embarrassment related to the condition. An ongoing health campaign in the study area providing free surgical treatment for pelvic organ prolapse enabled a study of the experiences related to the introduction of free health services targeting maternal morbidity.

CONCLUSIONS:
This study highlights how structural barriers prevent women living in a resource-constrained setting from receiving health care for a highly prevalent and readily treatable maternal morbidity such as pelvic organ prolapse. Our results illustrate that the provision of free quality services may dramatically alter both health-and illness-related perceptions and conduct in an extremely vulnerable population.

Life after pelvic organ prolapse surgery: a qualitative study in Amhara region, Ethiopia

BACKGROUND:
Women living in resource constrained settings often have limited knowledge of and access to surgical treatment for pelvic organ prolapse. Additionally, little is known about experiences during recovery periods or about the reintegration process for women who do gain access to medical services, including surgery. This study aimed to explore women’s experiences related to recovery and reintegration after free surgical treatment for pelvic organ prolapse in a resource-constrained setting.

METHODS:
The study had a qualitative design and used in-depth interviews in the data collection with a purposive sample of 25 participants, including 12 women with pelvic organ prolapse. Recruitment took place at the University of Gondar Hospital, Ethiopia, where women with pelvic organ prolapse had been admitted for free surgical treatment. In-depth interviews were carried out with women at the hospital prior to surgery and in their homes 5-9 months following surgery. Interviews were also conducted with health-care providers (8), representatives from relevant organizations (3), and health authorities (2). The fieldwork was carried out in close collaboration with a local female interpreter.

RESULTS:
The majority of the women experienced a transformation after prolapse surgery. They went from a life dominated by fear of disclosure, discrimination, and divorce due to what was perceived as a shameful and strongly prohibitive condition both physically and socially, to a life of gradually regained physical health and reintegration into a social life. The strong mobilization of family-networks for most of the women facilitated work-related help and social support during the immediate post-surgery period as well as on a long-term basis. The women with less extensive social networks expressed greater challenges, and some struggled to meet their basic needs. All the women openly disclosed their health condition after surgery, and several actively engaged in creating awareness about the condition.

CONCLUSIONS:
Free surgical treatment substantially improved the health and social life for most of the study participants. The impact of the surgery extended to the communities in which the women lived through increased openness and awareness and thus had the potential to ensure increased disclosure among other women who suffer from this treatable condition.