Publications by authors named "Abebe Bekele"

59 Publications

Distribution and determinants of serum high-sensitivity C-reactive protein in Ethiopian population.

Clin Chim Acta 2021 Mar 4;517:99-107. Epub 2021 Mar 4.

National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

Background: C-reactive protein (CRP) is an important inflammatory marker associated with different disease conditions, and its concentration differs among ethnicity. This study aimed to determine the distribution and determinants of serum high-sensitive method CRP (hsCRP) that can measure the typically low concentrations, among the Ethiopian population, for which there is no data.

Methods: A cross-sectional community-based study was conducted in April-June 2015. A total of 5162 individuals aged 15-69 were included. Behavioral, physical, and biochemical measurements were taken using the WHO STEPS non-communicable diseases (NCDs) risk factors assessment tool. Serum hsCRP was determined using Cobas Integra 400 Plus (Roche). Factors associated with hsCRP levels were also considered.

Results: median hsCRP was 0.80 mg/L (Interquartile range, 0.19-2.12) (males: 0.91 mg/L, females: 0.74 mg/L). More than 18% of the study participants had hsCRP greater than 3 mg/L according to the American Heart Association and Centers for Diseases Control and Preventions cut off value. Higher BMI, living in Somali and in Dire Dawa region, and not consuming of fruit or vegetables were independent risk factors for high hsCRP levels.

Conclusion: Serum hsCRP levels distribution is comparable to other studies. Until now, no data have been reported in the literature about the Ethiopian population.
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http://dx.doi.org/10.1016/j.cca.2021.02.013DOI Listing
March 2021

Assessing the knowledge, attitude and perception on workplace readiness regarding COVID-19 among health care providers in Ethiopia-An internet-based survey.

PLoS One 2021 4;16(3):e0247848. Epub 2021 Mar 4.

University of Global Health Equity, Kigali, Rwanda.

Background: Healthcare facilities in Ethiopia are responsible for collecting samples for testing and treating COVID-19 patients, providing COVID-19 information to staff, establishment of response teams, and provision of adequate personal protective equipment (PPE). Working at the frontlines against the pandemic, health care providers' level of knowledge about COVID-19, attitude towards their work, and confidence in the preparedness of their facilities are essential factors in mounting a successful response.

Objectives: This study investigated the knowledge level of HCP in Ethiopia on this novel coronavirus, and their perspectives on whether their workplaces have sufficient preparedness to handle this disease.

Methods: A self-administered online survey was conducted.

Results: The knowledge related to COVID-19 among HCPs was high, with an overall average of 91.5%. The majority of our respondents were supportive to the government's measures to minimize disease transmission, but most of them were also frustrated by how COVID affected their day to day lives. The majority of them were worried about contracting COVID at work and transmitting the infection to their families. Most respondents did not feel safe going to work (P<0.001). Apart from providing adequate information on COVID-19, most workplaces did not have sufficient PPE (P<000.1) and medical supplies (P<0.001). Close to 50% of respondents agreed and disagreed that their workplaces had clear protocols for handling COVID-19 (P = 0.144). Those who handled known COVID patients were more likely to agree their workplaces had clear protocols (OR = 2.69, P<0.001).

Conclusion: Improving supplies of PPEs and establishing a clear communicating protocol in handling COVID patients are highly recommended.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247848PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932089PMC
March 2021

Assessment of Delays in Emergency Surgical Care and Patient Postoperative Outcomes at a Referral Hospital in Northern Rwanda.

World J Surg 2021 Feb 26. Epub 2021 Feb 26.

University of Global Health Equity, Kigali, PO Box 6955, Kigali, Rwanda.

Background: Surgical interventions are cost-effective methods to save lives and prevent disabilities. Surgical delays and access to three Bellwether procedures are key monitoring indicators for universal access to safe and affordable surgical and anesthesia care and health system performance. This study assessed the delays in receiving surgical and anesthesia care for emergency surgical patients at a district hospital in Northern Rwanda.

Methods: A questionnaire was used to survey all emergency surgical patients who presented at the hospital between May and July 2020, to assess the delays in seeking (first) and reaching (second) care. In-hospital (third) delay and patient outcomes within the first 7 days postsurgery were collected by patient file auditing. Factors associated with third delay were identified through healthcare provider in-depth interviews.

Results: A total of 106 patients were surveyed, and nine healthcare providers were interviewed. The median was less than a day for first delay, 1 day for second delay, and 16.5 h for third delay for all emergency procedures. 20% of the Bellwether procedures were performed within two hours after arriving at the hospital. Factors affecting the delays included visiting a traditional healer, district of residence, referral system, income status, as well as shortage of surgeons and specialists, surgical supplies, and operating theaters.

Conclusion: Further research to study the cause of delays within the referral system is needed. Surgical outreach, equipment, and infrastructure would help to shorten in-hospital delays. Longer-term follow-up studies on patient complications and outcomes due to delay in surgical care are needed.
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http://dx.doi.org/10.1007/s00268-021-06013-7DOI Listing
February 2021

Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients.

BMC Surg 2021 Jan 2;21(1). Epub 2021 Jan 2.

Division of Cardiothoracic and Vascular Surgery, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.

Background: The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied.

Methods: A prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastric anastomosis for esophageal cancer. Intraoperative hypotension (IOH), defined as systolic blood pressure (SBP) < 90 mm Hg lasting more than 5 min, was recorded. Patients' 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables.

Result: A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 min. Intraoperative mean low SBP was 80 mmHg while the lowest record was 55 mmHg. IOH occurred in 51% (n = 29) of patients. Anastomotic leak occurred in 7% (n = 4) (OR 1.2, 95% CI 0.26-6.3; p = 0.76). In-hospital mortality was 5% (n = 3) (OR 1.44, 95% CI 0.22-9.3; p = 0.7) and 33% (n = 18) had prolonged hospital stay (OR 0.53, 95% CI 0.14-1.9; p = 0.34). The overall anastomotic leak rate was 13% (n = 7). Multivariate analysis (logistic regression model) showed SBP < 90 mmHg for more than 5 min was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p = 0.16) CONCLUSION: In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.
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http://dx.doi.org/10.1186/s12893-020-01015-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777395PMC
January 2021

Surgical data strengthening in Ethiopia: results of a Kirkpatrick framework evaluation of a data quality intervention.

Glob Health Action 2021 Jan;14(1):1855808

Department of Surgery, Addis Ababa University School of Medicine , Addis Ababa, Ethiopia.

: One key challenge in improving surgical care in resource-limited settings is the lack of high-quality and informative data. In Ethiopia, the (SS2020) project developed surgical key performance indicators (KPIs) to evaluate surgical care within the country. New data collection methods were developed and piloted in 10 SS2020 intervention hospitals in the Amhara and Tigray regions of Ethiopia. : To assess the feasibility of collecting and reporting new surgical indicators and measure the impact of a surgical Data Quality Intervention (DQI) in rural Ethiopian hospitals. : An 8-week DQI was implemented to roll-out new data collection tools in SS2020 hospitals. The Kirkpatrick Method, a widely used mixed-method evaluation framework for training programs, was used to assess the impact of the DQI. Feedback surveys and focus groups at various timepoints evaluated the impact of the intervention on surgical data quality, the feasibility of a new data collection system, and the potential for national scale-up. : Results of the evaluation are largely positive and promising. DQI participants reported knowledge gain, behavior change, and improved surgical data quality, as well as greater teamwork, communication, leadership, and accountability among surgical staff. Barriers remained in collection of high-quality data, such as lack of adequate human resources and electronic data reporting infrastructure. : Study results are largely positive and make evident that surgical data capture is feasible in low-resource settings and warrants more investment in global surgery efforts. This type of training and mentorship model can be successful in changing individual behavior and institutional culture regarding surgical data collection and reporting. Use of the Kirkpatrick Framework for evaluation of a surgical DQI is an innovative contribution to literature and can be easily adapted and expanded for use within global surgery.
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http://dx.doi.org/10.1080/16549716.2020.1855808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782003PMC
January 2021

The burden of injuries in Ethiopia from 1990-2017: evidence from the global burden of disease study.

Inj Epidemiol 2020 Dec 21;7(1):67. Epub 2020 Dec 21.

Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.

Background: Mortality caused by injuries is increasing and becoming a significant global public health concern. Limited evidence from Ethiopia on road traffic, unintentional and intentional injuries indicate the potential public health impact of problems resulting from such injuries. However, there is a significant evidence gap about the actual national burden of all injuries in Ethiopia. This data base study aimed to reveal the national burden of different injuries in Ethiopia.

Methodology: Data for this study were extracted from the estimates of the Global Burden of Diseases (GBD) 2017 study. Estimates of metrics such as Disability-Adjusted Life Years (DALYs), death rates, incidence, and prevalence were extracted. The metrics were then examined at different injury types, socio-demographic categories such as age groups and sex. Trends of the metrics were also explored for these categories across years from 2007 to 2017. The DALYs and deaths due to injuries in Ethiopia were also compared with other East African countries (specifically Kenya, Tanzania, Uganda, and Zambia) in order to evaluate regional differences across years, by sex and by different injury types such as transport injuries, unintentional injuries, self-harm and interpersonal violence.

Results: The age-standardized injury death rate has decreased to 69.4; 95% UI: (63.0-76.9) from 90.11; 95% UI: (82.41-97.73) in 2017 as compared with 2007. Road injury, falls, self-harm and interpersonal violence were the leading causes of mortality from injuries occurring in 2017. The age-standardized injury DALYs rate has decreased to 3328.2; 95% UI: (2981.7-3707.8) from 4265.55; 95% UI: (3898.11-4673.64) in 2017 as compared with 2007. The number of deaths resulting from injuries in 2017 was highest for males, children under 5 years, people aged 15-24.

Conclusion: The current age-standardized death rate and DALYs from injuries is high and the observed annual reduction is not satisfactory. There is a difference in gender and age regarding the number of deaths resulting from injuries. The data indicates that the current national efforts to address the public health impact of injuries in Ethiopia are not sufficient enough to bring a marked reduction. As a result, a more holistic approach to address all injuries is recommended in Ethiopia.
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http://dx.doi.org/10.1186/s40621-020-00292-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751094PMC
December 2020

Identifying a Basket of Surgical Procedures to Standardize Global Surgical Metrics: An International Delphi Study.

Ann Surg 2020 Nov 17. Epub 2020 Nov 17.

Department of Surgery, College of Medicine, University of Lagos & Pediatric Surgery Unit, Lagos University Teaching Hospital, Lagos, Nigeria, P.M.B. 12003, Lagos.

Objective: We aimed to define a globally applicable list of surgical procedures, or "basket", which could represent a health system's capacity to provide surgical care and standardize global surgical measurement.

Summary Of Background Data: Six indicators have been proposed to assess access to safe, affordable, timely surgical and anesthesia care, with a focus on laparotomy, caesarean section, and treatment of open fracture. However, comparability, particularly for these procedures, has been limited by a lack of definitional clarity and their overly broad scope.

Methods: We conducted a three round international expert Delphi exercise between April and June 2019 using REDCap to identify a set of procedures representative of surgical capacity. To be included, procedures had to be important for treating common conditions, well-defined, and impactful (i.e. well-recognized clinical or functional benefit). Procedures were eliminated or prioritized in each round, and those noted as "extremely" or "very important" by ≥ 50% of respondents in round 3 were included in the final "basket".

Results: Altogether 331 respondents from 78 countries participated in the Delphi process. A final basket of 32 procedures representing diseases categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection were identified as important for inclusion to assess surgical capacity.

Conclusions: This surgical basket could allow a more standardized assessment of a country's surgical system. Further testing and refinement will likely be needed, but this basket can be used immediately to guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.
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http://dx.doi.org/10.1097/SLA.0000000000004611DOI Listing
November 2020

Assessment of serum electrolytes and kidney function test for screening of chronic kidney disease among Ethiopian Public Health Institute staff members, Addis Ababa, Ethiopia.

BMC Nephrol 2020 11 18;21(1):494. Epub 2020 Nov 18.

Department of Medical Biochemistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Background: Chronic kidney disease (CKD), which is characterized by its asymptomatic nature until an end stage, is one of the most common public health problems in the world. Thus, a regular checkup, especially for those individuals with high risk groups is inevitably important, and the screening has been done with laboratory findings. However, in developing countries, including Ethiopia screening for CKD are rarely done, and it is becoming common to hear sudden death from the kidney failure. Therefore, we aimed to screen serum electrolyte levels and estimated glomerular filtration rate (eGFR) among Ethiopian Public Health Institute (EPHI) staff members for an early detection of CKD and to identify the factors associated with it.

Methods: A cross-sectional study was conducted from July 1 to October 28, 2018 among EPHI staff members. The level of serum creatinine and electrolytes were measured using COBAS 6000 analyzer. Then, eGFR was calculated using MDRD and CKD-EPI equations. Data analysis were done using SPSS version 20, and the factors associated with the outcome variable were assessed using logistic regression. P values < 0.05 were considered as statistically significant.

Results: This study found that 3.6 and 1.9% of the study participants were at CKD stage II by MDRD and CKD-EPI equations, respectively. Out of the total study participants, 9.5% had hyperkalemia (serum potassium level > 5.0 mmol/L) and 8.5% had hypocalcemia (serum calcium level < 2.15 mmol/L). An older age (P = 0.006), high BMI (P = 0.045) and previous history of CVDs (P = 0.033) were found to be significantly associated factors with reduced glomerular filtration rate. Nine percent of the study participants were obese, 6.1% had family history of kidney failure, 18% self-reported history of hypertension, 3.4% diabetic and 5.3% had CVDs. About 51.2% of the study participants were males, and the majorities, (66%) of the study participants were found to be alcohol consumers.

Conclusions: The prevalence of a stage II kidney disease was relatively low and none of the participants was under serious kidney disease (GFR < 60 mmol/min/1.73m). An older age, high BMI and previous history of CVDs were significantly associated with reduced GFR. Hyperkalemia and hypokalemia were the major electrolyte disorders in the study participants.
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http://dx.doi.org/10.1186/s12882-020-02166-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672884PMC
November 2020

Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries.

BMJ Open 2020 10 10;10(10):e038842. Epub 2020 Oct 10.

Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA

Context And Objectives: Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions.

Design: Secondary analysis of existing cross-sectional survey data.

Setting: We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country.

Outcome Measures: We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities.

Results: Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1-2 hypertension (28%-83%). Availability was low for type 1 diabetes (1%-70%), type 2 diabetes (3%-57%), asthma (0%-7%) and acute presentations of diabetes (0%-26%) and asthma (0%-4%). Few hospitals had equipment or medications for heart failure (0%-32%), rheumatic heart disease (0%-23%), hypertensive emergencies (0%-64%) or acute minor surgical conditions (0%-5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability.

Conclusions: Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.
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http://dx.doi.org/10.1136/bmjopen-2020-038842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549470PMC
October 2020

The burden of cardiovascular diseases in Ethiopia from 1990 to 2017: evidence from the Global Burden of Disease Study.

Int Health 2020 Sep 18. Epub 2020 Sep 18.

Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

In Ethiopia, evidence on the national burden of cardiovascular diseases (CVDs) is limited. To address this gap, this systematic analysis estimated the burden of CVDs in Ethiopia using the Global Burden of Disease (GBD) 2017 study data. The age-standardized CVD prevalence, disability-adjusted life years (DALYs) and mortality rates in Ethiopia were 5534 (95% uncertainty interval [UI] 5310.09 - 5774.0), 3549.6 (95% UI 3229.0 - 3911.9) and 182.63 (95% UI 165.49 - 203.9) per 100 000 population, respectively. Compared with 1990, the age-standardized CVD prevalence rate in 2017 showed no change. But significant reductions were observed in CVD mortality (54.7%), CVD DALYs (57.7%) and all-cause mortality (53.4%). The top three prevalent CVDs were ischaemic heart disease, rheumatic heart disease and stroke in descending order. The reduction in the mortality rate due to CVDs is slower than for communicable, maternal, neonatal and nutritional disease mortalities. As a result, CVDs are the leading cause of mortality in Ethiopia. These findings urge Ethiopia to consider CVDs as a priority public health problem.
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http://dx.doi.org/10.1093/inthealth/ihaa069DOI Listing
September 2020

Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia.

BMJ Open 2020 09 15;10(9):e040868. Epub 2020 Sep 15.

Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.

Introduction: Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention's effectiveness on care utilisation for common childhood illnesses.

Methods: We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses.

Results: There were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2-59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences -4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services.

Conclusion: We found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period.

Trial Registration Number: ISRCTN12040912.
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http://dx.doi.org/10.1136/bmjopen-2020-040868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493123PMC
September 2020

Quality antenatal care services delivery at health facilities of Ethiopia, assessment of the structure/input of care setting.

BMC Health Serv Res 2020 Jun 1;20(1):485. Epub 2020 Jun 1.

Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

Background: According to the Donabedian model, the assessment for the quality of care includes three dimensions. These are structure, process, and outcome. Therefore, the present study aimed at assessing the structural quality of Antenatal care (ANC) service provision in Ethiopian health facilities.

Methods: Data were obtained from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. The SARA was a cross-sectional facility-based assessment conducted to capture health facility service availability and readiness in Ethiopia. A total of 764 health facilities were sampled in the 9 regions and 2 city administrations of the country. The availability of equipment, supplies, medicine, health worker's training and availability of guidelines were assessed. Data were collected from October-December 2017. We run a multiple linear regression model to identify predictors of health facility readiness for Antenatal care service. The level of significance was determined at a p-value < 0.05.

Result: Among the selected health facilities, 80.5% of them offered Antenatal care service. However, the availability of specific services was very low. The availability of tetanus toxoid vaccination, folic acid, iron supplementation, and monitoring of hypertension disorder was, 67.7, 65.6, 68.6, and 75.1%, respectively. The overall mean availability among the ten tracer items that are necessary to provide quality Antenatal care services was 50%. In the multiple linear regression model, health centers, health posts and clinics scored lower Antenatal care service readiness compared to hospitals. The overall readiness index score was lower for private health facilities (β = - 0.047, 95% CI: (- 0.1, - 0.004). The readiness score had no association with the facility settings (Urban/Rural) (p-value > 0.05). Facilities in six regions except Dire Dawa had (β = 0.067, 95% CI: (0.004, 0.129) lower readiness score than facilities in Tigray region (p-value < 0.015).

Conclusion: This analysis provides evidence of the gaps in structural readiness of health facilities to provide quality Antenatal care services. Key and essential supplies for quality Antenatal care service provision were missed in many of the health facilities. Guaranteeing properly equipped and staffed facilities shall be a target to improve the quality of Antenatal care services provision.
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http://dx.doi.org/10.1186/s12913-020-05372-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268345PMC
June 2020

Integration and Sustainability of Electronic Surgical Logbooks in Sub-Saharan Africa.

World J Surg 2020 10;44(10):3259-3267

The College of Surgeons of East Central and Southern Africa (COSECSA), Arusha, Tanzania.

Background: Countries in Sub-Saharan Africa lack adequate surgical workforces to achieve safe and affordable care for their populations. The Global Surgery movement highlights the urgent need to address this situation. Interventions include not only financial, material and infrastructural support, but also collaborative information flow to support surgical training. In 2015, an electronic logbook was launched for surgical trainees across Sub-Saharan Africa.

Objectives: To assess the integration and context sustainability of surgical e-logbooks in Sub-Saharan Africa.

Methods: In January 2019, a survey analysis of surgical trainees was employed using quantitative and qualitative methods. Participants (active trainees and recent fellows) completed an anonymous internet-based questionnaire evaluating end-user feedback, perceptions and self-reported compliance. Multi-point Likert Scale measures and free-text thematic analysis were used.

Results: 358 (68.19%) eligible individuals across 21 Sub-Saharan countries and seven surgical specialties voluntarily participated. The e-resource demonstrated integration into local curricula with the majority of users maintaining activity and reporting moderate-high compliance. Context appropriateness measures were high with 203 (69.76%) deeming it convenient to use. The principle obstacle to compliance was internet connectivity (74, 25.96%), while behavioural factors including supervisor engagement were implicated. The e-logbook demonstrated future sustainability with the majority (243, 78.14%) of participants intent on maintaining usage beyond completion of surgical training.

Conclusions: We describe the successful integration and sustainability of electronic surgical logbooks for trainees across Sub-Saharan Africa. However context-appropriate resources are essential for Low- and Middle-Income Countries. Internet connectivity may hinder the achievement of several Global Surgery objectives in Sub-Saharan Africa.
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http://dx.doi.org/10.1007/s00268-020-05613-zDOI Listing
October 2020

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi-disciplinary Stakeholder Exercise.

World J Surg 2020 09;44(9):2903-2918

Institute of Applied Health Research, University of Birmingham, Birmingham, UK.

Background: Whilst injuries are a major cause of disability and death worldwide, a large proportion of people in low- and middle-income countries lack timely access to injury care. Barriers to accessing care from the point of injury to return to function have not been delineated.

Methods: A two-day workshop was held in Kigali, Rwanda in May 2019 with representation from health providers, academia, and government. A four delays model (delays to seeking, reaching, receiving, and remaining in care) was applied to injury care. Participants identified barriers at each delay and graded, through consensus, their relative importance. Following an iterative voting process, the four highest priority barriers were identified. Based on workshop findings and a scoping review, a map was created to visually represent injury care access as a complex health-system problem.

Results: Initially, 42 barriers were identified by the 34 participants. 19 barriers across all four delays were assigned high priority; highest-priority barriers were "Training and retention of specialist staff", "Health education/awareness of injury severity", "Geographical coverage of referral trauma centres", and "Lack of protocol for bypass to referral centres". The literature review identified evidence relating to 14 of 19 high-priority barriers. Most barriers were mapped to more than one of the four delays, visually represented in a complex health-system map.

Conclusion: Overcoming barriers to ensure access to quality injury care requires a multifaceted approach which considers the whole patient journey from injury to rehabilitation. Our results can guide researchers and policymakers planning future interventions.
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http://dx.doi.org/10.1007/s00268-020-05571-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385009PMC
September 2020

Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health.

JMIR Res Protoc 2020 May 19;9(5):e16493. Epub 2020 May 19.

Department of Oncology and Radiotherapy, School of Medicine, Health Science College, Addis Ababa University, Addis Ababa, Ethiopia.

Background: Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations.

Objective: The project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area.

Methods: This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions.

Results: The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021.

Conclusions: The project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication.

International Registered Report Identifier (irrid): DERR1-10.2196/16493.
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http://dx.doi.org/10.2196/16493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267985PMC
May 2020

Prevalence of Hyperhomocysteinaemia and Associated Factors among Ethiopian Adult Population in a 2015 National Survey.

Biomed Res Int 2020 11;2020:9210261. Epub 2020 Jan 11.

Center for Food Science and Nutrition, College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Hyperhomocysteinaemia (HHcy) is an independent risk factor for major cardiovascular diseases, but data on the prevalence and predictors of HHcy in low- and middle-income countries like Ethiopia are scant. The aim of this study was to estimate the prevalence of HHcy and associated risk factors in the Ethiopian adult population. A cross-sectional survey on risks of noncommunicable diseases (NCDs) using the STEPwise approach to surveillance (STEPS) survey was conducted between April and June 2015. A total of 4,175 study participants were surveyed. Serum homocysteine (Hcy) and metabolic profile were determined using Cobas Integra 400 Plus and CardioChek PA analyzer, respectively. Factors associated with HHcy were determined using logistic regression. The mean serum tHcy concentration was 14.6 mol/L, with 16.4 mol/L in males and 13.4 mol/L in females. Overall, 38% had HHcy, with figures in males (49%) higher than females (30%). Increased age, being male, and high blood pressure and/or taking blood pressure medication, as well as low consumption of fruit and/or vegetables, were independent risk factors for HHcy. In conclusion, the prevalence of HHcy among the adult Ethiopian population is alarmingly high. Improving diets through the promotion of fruit and vegetable consumption is needed to reduce the risk of NCDs.
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http://dx.doi.org/10.1155/2020/9210261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201487PMC
February 2021

Global Surgery Pro-Con Debate: A Pathway to Bilateral Academic Success or the Bold New Face of Colonialism?

J Surg Res 2020 08 10;252:272-280. Epub 2020 May 10.

Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.

Global surgery, especially academic global surgery, is of tremendous interest to many surgeons. Classically, it entails personnel from high-income countries going to low- and middle-income countries and engaging in educational activities as well as procedures. Academic medical personnel have included students, residents, and attendings. The pervasive notion is that this is a win-win situation for the volunteers and the hosts, that is, a pathway to bilateral academic success. However, a critical examination demonstrates that it can easily become the bold new face of colonialism of a low- and middle-income country by a high-income country.
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http://dx.doi.org/10.1016/j.jss.2020.01.032DOI Listing
August 2020

Distribution and characteristics of androgen receptor (AR) in breast cancer among women in Addis Ababa, Ethiopia: A cross sectional study.

PLoS One 2020 6;15(5):e0232519. Epub 2020 May 6.

School of Medical Sciences, Orebro University, Orebro, Sweden.

Evaluation of the role of androgen receptor (AR) in the biology of breast cancer is an emerging area of research. There are compelling evidences that AR expression may be used to further refine breast cancer molecular subtyping with prognostic and therapeutic implications. Many studies indicated co-expression of AR with the hormonal receptors in breast cancer has a favorable prognosis. AR is also investigated by many researchers as a potential therapeutic target in treatment of breast cancer. Studies on the frequency and distribution of AR in breast cancer among Africans is barely available. Given the heightened interest to understand its role in breast cancer, we determined AR expression and assessed its association with clinicopathological parameters among Ethiopian women. In this study, 112 newly diagnosed patient with invasive breast cancer at Tikur Anbessa Specialized Hospital were enrolled. Immunohistochemical assessment of AR, ER, PR, Ki67 and HER2 were performed using tissue microarrays (TMA) constructed from their primary tumor block. Out of the 112 participants, 91 (81%) were positive for AR expression and the remaining 21 participants (19%) were negative for AR expression. Expression of AR in ER+, HER2+ and TNBC cases were 93%, 83% and 48% respectively. Our study reveals AR is expressed in a significant number of breast cancers patients and this may indicate that breast cancers cases in Ethiopia have favorable prognosis and could benefit from progresses in AR targeted treatments. Since AR expression has important consequences on the prognosis and treatment of breast cancer, further studies with an increased number of participants is necessary to confirm our reports.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232519PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202607PMC
July 2020

Value and Feasibility of Telephone Follow-Up in Ethiopian Surgical Patients.

Surg Infect (Larchmt) 2020 Aug 16;21(6):533-539. Epub 2020 Apr 16.

Department of Surgery, Black Lion Hospital, Addis Ababa University, Addis Ababa, Ethiopia.

Surgical site infections (SSIs) represent a major cause of morbidity and mortality in Ethiopia. Lack of post-discharge follow-up, including identification of SSIs, is a barrier to continued patient care, often because of financial and travel constraints. As part of a surgical quality improvement initiative, we aimed to assess patient outcomes at 30 days post-operative with a telephone call. We conducted mobile telephone follow-up as part of Lifebox's ongoing Clean Cut program, which aims to improve compliance with intra-operative infection prevention standards. One urban tertiary referral hospital and one rural district general hospital in Ethiopia were included in this phase of the study; hospital nursing staff called patients at 30 days post-operative inquiring about signs of SSIs, health-care-seeking behavior, and treatments provided if patients had any healthcare encounters since discharge. A total of 701 patients were included; overall 77% of patients were reached by telephone call after discharge. The rural study site reached 362 patients (87%) by telephone; the urban site reached 176 patients (62%) (p < 0.001). Of the 39 SSIs identified, 19 (49%) were captured as outpatient during the telephone follow-up (p < 0.001); 22 (34%) of all complications were captured following discharge (p < 0.001). Telephone follow-up improved from 65%-78% in the first half of project implementation to 77%-89% in the second half of project implementation. Telephone follow-up after surgery in Ethiopia is feasible and valuable, and identified nearly half of all SSIs and one-third of total complications in our cohort. Follow-up improved over the course of the program, likely indicating a learning curve that, once overcome, is a more accurate marker of its practicability. Given the increasing use of mobile telephones in Ethiopia and ease of implementation, this model could be practical in other low-resource surgical settings.
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http://dx.doi.org/10.1089/sur.2020.054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398427PMC
August 2020

Sex Disparities in the Global Burden of Surgical Disease.

World J Surg 2020 07;44(7):2139-2143

Stanford University School of Medicine, Stanford, CA, USA.

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http://dx.doi.org/10.1007/s00268-020-05484-4DOI Listing
July 2020

Factors associated with health care provider knowledge on abortion care in Ethiopia, a further analysis on emergency obstetric and newborn care assessment 2016 data.

BMC Health Serv Res 2019 Dec 30;19(1):1014. Epub 2019 Dec 30.

Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, 1242/1000, Addis Ababa, Ethiopia.

Background: Abortion is one of the major direct causes of maternal death, accounting for 7.9% globally. In Africa, 5.5 million women have unsafe abortions annually. Although maternal deaths due to complications of abortion have declined in Ethiopia, women still die from complications. Few studies have focused on providers' clinical knowledge. This study investigates the level of health workers' knowledge of comprehensive abortion care and its determinants in Ethiopia.

Methods: Data from the national emergency obstetric and newborn care (EmONC) assessment was used. A total of 3804 facilities that provided institutional deliveries in the 12 months before the assessment were included. Provider knowledge was assessed by interviewing a single provider from each facility. Criteria for selection included: having attended the largest number of deliveries in the last one or two months. A summary knowledge score was generated based on the responses to three knowledge questions related to immediate complications of unsafe abortion, how a woman should be clinically managed and what the counselling content should contain. The score was classified into two categories (< 50% and > =50%). Logistic regression was used to determine individual and facility-level factors associated with the summary knowledge score.

Result: A total of 3800 providers participated and the majority were midwives, nurses and health officers. On average, providers identified approximately half or fewer of the expected responses. The multivariate model showed that midwives and nurses (compared to health officers), being female, and absence of training or practice of manual vacuum aspiration were associated with lower knowledge levels. Important facility level factors protective against low knowledge levels included employment in Addis Ababa, being male and having internet access in the facility.

Conclusion: To increase knowledge levels among providers, pre- and in-service training efforts should be particularly sensitive to female providers who scored lower, ensure that more midlevel providers are capable of performing manual vacuum aspiration as well as provide special attention to providers in the Gambella.
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http://dx.doi.org/10.1186/s12913-019-4857-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936068PMC
December 2019

Healthcare workers' clinical knowledge on maternal and newborn care in Ethiopia: findings from 2016 national EmONC assessment.

BMC Health Serv Res 2019 Nov 29;19(1):915. Epub 2019 Nov 29.

Averting Maternal Death and Disability, Columbia University, NY and FHI 360, Columbia, North Carolina, USA.

Background: Improving maternal and newborn health indicators are key if Ethiopia is to achieve the Sustainable Development Goals. To do so, women need access to skilled attendance at birth and emergency obstetric and newborn care. To maximize their impact, understanding gaps in workers' knowledge is required to remedy the weakness. This assessment determines knowledge levels of clinical management of maternal and newborn healthcare and factors that influence knowledge.

Methods: This study used data from the National Emergency Obstetric and Neonatal Care assessment conducted in 2016. Provider knowledge for MNH was assessed by interviewing providers. Respondents were scored on each question by calculating the number of correct responses provided out of the total possible answers, and standardizing this to a scale of 100. Mixed linear regression was used to determine individual and contextual factors associated with the score.

Results: A total of 3800 interviews with complete data were included in this study. Most respondents were diploma midwives (73%), BSc midwives (11%) and diploma nurses (10%). On average, midwives scored 60 out of 100 on the question regarding the primary aspects of focused antenatal care and elements of a birth plan. Half of the midwives and health officers, and one-third of nurses knew to provide a loading dose of magnesium sulphate. Midwives scored 90% on the steps of active management of third stage of labor. In the mixed linear regression, working in a private for profit facility, health center/clinic, rural area, or in a facility with a protocol on referral/counter referral predicted lower knowledge scores. More positive scores were associated with work environments that had a computer, internet, and protocols on safe abortion care, management of selected obstetric topics, integrated management of pregnancy, childbirth, postnatal, and newborn, care for low birth weight including kangaroo mother care, and treatment of infection in young infants.

Conclusion: With regard to most knowledge related questions, health officers and midwives scored similarly. Providers scored substantially better on routine intrapartum and newborn care than on aspects related to care for complications. A substantial proportion of providers indicated that they would never give a loading dose of magnesium sulphate.
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http://dx.doi.org/10.1186/s12913-019-4758-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884887PMC
November 2019

The rapid scale up of medical education in Ethiopia: Medical student experiences and the role of e-learning at Addis Ababa University.

PLoS One 2019 5;14(9):e0221989. Epub 2019 Sep 5.

Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America.

Background: In response to a physician shortage in Ethiopia, the number of medical students admitted to public universities was rapidly increased through a "flooding" policy.

Objectives: To assess medical student perceptions on the impact of the "flooding" policy on medical education and e-learning initiatives, as well as plans for future emigration.

Design: A cross-sectional survey of medical students at AAU was implemented in 2014. Attitude and practice items were assessed using a Likert scale. Logistic regression analysis was performed to identify characteristics associated with an interest in future emigration.

Results: 673 (99.6%) of 676 students approached completed the survey, representing 39.5% of all 1705 medical students enrolled at AAU in 2014. Most students felt the "flooding" policy had a negative impact on their medical education and >90% felt there was not adequate infrastructure to support the increased student body. E-learning activities to accommodate increased class size included distribution of electronic tablets, but at the time of the survey only 34.8% of students still had a working tablet and 82.3% reported problems with internet connectivity. Most preclinical students (85.1%) who had attended live-streamed lectures preferred traditional classroom lectures. Half of the students (49.5%) intended to practice medicine in Ethiopia. Independent risk factors for planning to emigrate included age <21 years (aOR = 1.30, 95% CI 1.04, 1.97); having applied to medical school for reasons other than "wanting to be a physician" (aOR = 1.55, 95% CI 1.14, 2.20), and not believing that "flooding" policy would increase the number of physicians working in Ethiopia (aOR = 1.87, 95% CI 1.33, 2.58).

Conclusions: The "flooding" policy lead to significant educational challenges that were not fully alleviated by e-learning initiatives. Concomitant increases in resources for infrastructure development and faculty expansion are needed to maintain quality medical education. Additional research is needed on factors that influence medical graduates decision to emigrate.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221989PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728036PMC
March 2020

Making all deaths after surgery count.

Lancet 2019 06 27;393(10191):2588. Epub 2019 Jun 27.

College of Surgeons of East, Central and Southern Africa, Arusha, Tanzania.

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http://dx.doi.org/10.1016/S0140-6736(19)31113-4DOI Listing
June 2019

CYP2J27 Genotype Predicts Risk of Chemotherapy-Induced Hematologic Toxicity and Reduced Relative Dose Intensity in Ethiopian Breast Cancer Patients.

Front Pharmacol 2019 14;10:481. Epub 2019 May 14.

Division of Clinical Pharmacology, Department of Laboratory of Medicine, Karolinska Institutet Huddinge, Stockholm, Sweden.

Chemotherapy-induced hematologic toxicity is the primary reasons of dose reductions and/or delays, low relative dose intensity (RDI), and predicts anticancer response. We investigated the incidence and predictors of chemotherapy-induced hematologic toxicities and reduced RDI in Ethiopian breast cancer patients, and implication of pharmacogenetics variations. Breast cancer patients ( = 249) were enrolled prospectively to receive cyclophosphamide based chemotherapy. Hematological toxicity (neutropenia, anemia, and thrombocytopenia) were monitored throughout chemotherapy cycle. The primary and secondary outcomes were incidence of grade 3 or 4 toxicity and reduced RDI, respectively. ), , and genotyping were done. Cox proportional hazard and logistic regression were used to estimate risk predictors of toxicity and reduced RDI, respectively. Majority (73.5%) of the patients were < 45 years of age. The incidence of grade 3 or 4 hematological toxicity was 51.0% (95% CI = 44.54-57.46%). Multivariate Cox proportional hazard regression indicated genotype [Hazard ratio (HR) = 1.82; 95% CI = 1.14-2.90], pretreatment grade 1 leukopenia (HR = 2.75; 95% CI = 1.47-5.15) or grade 1 or 2 neutropenia (HR = 2.75; 95% CI = 1.73-4.35) as significant predictors of hematologic toxicities. The odds of having hematologic toxicities was lower in carriers ( = 0.024). The prevalence of reduced RDI was 56.6% (95% CI = 50.3-62.9%). Higher risk of reduced RDI was associated with allele [Adjusted odds ratio (AOR) = 2.79; 95% CI = 1.21-6.46], BMI ≤ 18.4 kg/m (AOR = 5.98; 95% CI = 1.36-26.23), baseline grade 1 leukopenia (AOR = 6.09; 95% CI = 1.24-29.98), and baseline neutropenia (AOR = 3.37; 95% CI = 1.41-8.05). The odds of receiving reduced RDI was lower in patients with genotype (AOR = 0.19; 95% CI = 0.06-0.77). We report high incidence of chemotherapy-induced hematological toxicities causing larger proportion of patients to receive reduced RDI in Ethiopian breast cancer patients. Patients carrying allele and low baseline blood counts are at a higher risk for chemotherapy-induced hematologic toxicities and receiving reduced RDI, and may require prior support and close follow up during chemotherapy.
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http://dx.doi.org/10.3389/fphar.2019.00481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527746PMC
May 2019

Healthcare Leaders Develop Strategies for Expanding National Surgical, Obstetric, and Anaesthesia Plans in WHO AFRO and EMRO Regions.

World J Surg 2019 Feb;43(2):360-367

Emergency & Essential Surgical Care Programme, World Health Organization, Geneva, Switzerland.

Background: Worldwide, five billion people lack access to safe, affordable surgical, obstetric, and anaesthesia (SOA) care when needed. In many countries, a growing commitment to SOA care is culminating in the development of national surgical, obstetric, and anaesthesia plans (NSOAPs) that are fully embedded in the National Health Strategic Plan. This manuscript highlights the content and outputs from a World Health Organization (WHO) lead workshop that supported country-led plans for improving SOA care as a component of health system strengthening.

Methods: In March 2018, a group of 79 high-level global SOA stakeholders from 25 countries in the WHO AFRO and EMRO regions gathered in Dubai to provide technical and strategic guidance for the creation and expansion of NSOAPs.

Results: Drawing on the experience and expertise of represented countries that are at different stages of the NSOAP process, topics covered included (1) the global burden of surgical, obstetric, and anaesthetic conditions; (2) the key principles and components of NSOAP development; (3) the critical evaluation and feasibility of different models of NSOAP implementation; and (4) innovative financing mechanisms to fund NSOAPs.

Conclusions: Lessons learned include: (1) there is unmet need for the establishment of an NSOAP community in order to provide technical support, expertise, and mentorship at a regional level; (2) data should be used to inform future priorities, for monitoring and evaluation and to showcase advances in care following NSOAP implementation; and (3) SOA health system strengthening must be uniquely prioritized and not hidden within other health strategies.
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http://dx.doi.org/10.1007/s00268-018-4819-zDOI Listing
February 2019

Trends in Retention and Decay of Basic Surgical Skills: Evidence from Addis Ababa University, Ethiopia: A Prospective Case-Control Cohort Study.

World J Surg 2019 01;43(1):9-15

Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.

Introduction: While prior studies have evaluated surgical skills simulation and retention in highly resourced environments, there is paucity of data on the retention of surgical skills taught in simulation laboratory to undergraduate students, and virtually none from low-resource settings. We aimed to evaluate the trends in retention/decay of surgical skills among medical students in Ethiopia and determine whether regular intervention in the form of intermittent skills testing can aid retention.

Methods: Forty-four final year medical students were randomly divided into two cohorts of 22 students each. All 44 were trained in surgical instrument identification, simple interrupted suturing and one-handed knot tying. A previously validated, standardized assessment was performed before training, immediately after training, and then at 6 weeks, 3 months, 6 months and 1 year for cohort 1, and before training, immediately after training, and at 6 months and 1 year for cohort 2. All areas learned were tested for general decay.

Results: The baseline mean scores of surgical skills were 3.8/30 for instrument identification, 3.3/15 for one-handed knot tying, and 1.35/15 for suturing. At the end of the training, mean scores improved to 26.6/30, 11.2/15 and 11.1/15 (instrument identification +599% and +772%, knot tying +447% and +417%, suturing +237% and +260%, respectively, for Cohort I and II). At 6 months and 1 year, there was a significant drop in all the three areas tested, especially in knot tying and suturing. There was no statistically significant difference between the two cohorts.

Conclusions: While our surgical skills course is an effective means to teach surgical skills to medical students, there is significant decay in abilities after 6 months. Conducting regular assessments does not appear to have any effect in helping students retain these skills. We recommend such surgical skills training be conducted at appropriate intervals, such as just before internship, to prepare student for active surgical practice.
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http://dx.doi.org/10.1007/s00268-018-4752-1DOI Listing
January 2019

Adequacy of Pathologic Reports of Invasive Breast Cancer From Mastectomy Specimens at Tikur Anbessa Specialized Hospital Oncology Center in Ethiopia.

J Glob Oncol 2018 07;4:1-12

Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA.

Purpose Although information from pathology reports is essential to the care of individuals with cancer and to population-level cancer control, no systematic evidence exists regarding the adequacy of breast pathology reporting in Ethiopia. This study audited pathology reports of mastectomy specimens from patients evaluated at the Tikur Anbessa Specialized Hospital Oncology Center in Addis Ababa, Ethiopia. Methods Mastectomy pathology reports from February 2014 through January 2016 were assessed for gross and microscopic information considered by the Breast Cancer Initiative 2.5 (BCI 2.5; formerly the Breast Health Global Initiative) guideline to be necessary for care of patients with breast cancer stratified according to basic, limited, and enhanced resource settings. Results Fewer than two thirds (61.6%) of the 417 reports we reviewed included all four of the BCI 2.5 basic pathology data elements we could evaluate with available data (tumor category, lymph node category, histologic type, and histologic grade). Only 1.0% of reports included all three pathology data elements recommended for limited resource settings (estrogen receptor status, margin status, and lymphovascular invasion). Several elements were significantly more likely to be noted in reports from nonpublic hospitals than from public hospitals. Although only three of 417 reports included checklists or templates, all three of these reports included all of the basic pathology information, and they all included at least two of the three limited pathology elements not already on the basic list. Conclusion More than one third (38.4%) of mastectomy pathology reports did not meet BCI 2.5 standards for basic resource settings. Quality measurement and improvement programs and capacity-building interventions by national pathology and oncology organizations, collaboration with medical and public health organizations in neighboring countries, adoption of synoptic reporting templates, use of electronic pathology reporting, and histotechnology and histopathology training collaborations with laboratories in high-resource regions are recommended.
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http://dx.doi.org/10.1200/JGO.17.00198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223529PMC
July 2018