Ethiopian Journal of Pediatrics and Child Health

Child nutrition in Ethiopia: A Review Article

Ferew Lemma — 2014-01-31

UNIGME report 2013, APR report 2013 2. Ministry of Education (2011): Education Statistics Annual Abstract 2010/11. EMIS, Planning and Resource Mobilization Directorate (2010/11), Ministry of Education, September 2011, Addis Ababa, Ethiopia 3. Central Statistical Agency [Ethiopia] and ICF International (2012): Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International. 4. MOFED (2012): Ethiopia’s Progress Towards Eradicating Poverty: An Interim Report on Poverty Analysis Study (2010/11). Development Planning and Research Directorate, Ministry of Finance and Economic Development. March, 2012, Addis Ababa, Ethiopia 5. Lancet Maternal and Child Nutrition Series (2013). 382: 427–51. Maternal and child undernutrition and overweight in low-income and middle-income countries. June 6, 2013. http://dx.doi.org/10.1016/. S0140-6736(13)60937-X 6. NNP, Government of Ethiopia, June 2013, Addis Ababa, Ethiopia 7. World Bank, Repositioning Nutrition as Central for Development. 2006, World Bank: Washington
DC. 8. Shrimpton R, V.C., de Onis M, Lima RC, Blossner M, Clugston G., Worldwide timing of growth faltering: implications for nutritional interventions. Pediatrics, 2001. 107: p. E75. 9. Shrimpton et al 2012 10. Martorell, R., Kettel Khan, L. & Schroeder, D. G., Reversibility of stunting: epidemiological findings in children from developing countries. Eur. J. Clin. Nutr., 1994. 48: p. S45-S57.

Pediatric HIV treatment, care and support services at health center levels in Ethiopia

Solomie Jebessa — 2014-01-31

Background: Ethiopia is one of the countries hit hard by the HIV epidemic. There is low enrollment rate to care & treatment among HIV patients in general and pediatric HIV cases in particular. Decentralization to primary health care (PHC) with task shifting to mid-level health workers has been the main strategy used to improve access to pediatric HIV care and treatment. This study attempts to compare the knowledge and skill of health care providers at PHC level and the enrollment rate of pediatrics HIV infected and HIV exposed infants and overall quality of care at the supported and non-supported health centers. The support provided was capacity building of health care providers through training and intensive mentoring.
Methods: An analytic retrospective cohort study was conducted on 117 health centers in Oromia, Tigrai, Amhara and Southern nations and nationalities and peoples’ (SNNPR) regions. Two categories of study population were compared:, the health centers & the health care providers in ’the supported health centers’ with the health centers & the health care providers in ‘non-supported health centers’. Pretested data collection tool was used to collect data from both categories of study population, specifically the health care providers and from the health centers national HIV/ART registers.
Results : A total of 117 health care providers were assessed, 50.4% were females, their mean age was 30.32 (±6.24) with range between 22 and 50 yrs.; 62.4% were married; 68.4% were diploma nurses, 23.9% were health officers and the rest 7.7% were BSC(degree) nurses.
Knowledge and skills on clinical examination and diagnosis was found to be ‘good' (≥70%) in the supported health centers (86.1%) compared to the non-supported (50%) with RR (95%CI) = 1.72(1.23, 2.41). Similarly skill in clinical laboratory, Cotrimoxazole and ART drug prescription, ART patient follow-up for toxicity and failure; HIV Exposed infant follow up and diagnosis and keeping good medical record was found to be better in the supported than non-supported ones and the difference was statistically significant. A paired sample T- test showed statistically significant result with mean increment of 20.61 in the enrollment of new pediatrics patients on HIV care and mean increment of 13.93 of those enrolled on ART care in the supported health centers between the two years period.
Conclusion: Over all on most of the parameters measured the supported clinics showed better quality of care. Moreover, this study has shown that middle level health workers can manage pediatrics patients effectively at PHC setting if provided with technical support. Data from this study also identified gaps and weaknesses that need to be addressed but also reviewed strengths in the current approach.

Prevalence and risk factors of Urolithiasis among children age less than 14 years in Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia

Gesit Metaferia — 2014-01-31

Background: - Urolithiasis in the pediatric age group plays an important urologic problem, not only in parts of the world with a high incidence of stone disease such as the near and Far East, but also in the developing and industrialized countries. Pediatric urolithiasis is associated with significant morbidity, particularly recurrent stones as well as the development and progression of renal dysfunction, thus, should not be underestimated. This study will assess the prevalence and risk factors for urolithiasis in children in a tertiary teaching hospital.
Objectives: To assesses the prevalence and risk factors of urolithiasis, in children whose age is less than 14 years in Tikur Anbessa Specialized Teaching Hospital.
Materials and methods: This is a retrospective cohort study conducted in admitted patients with the diagnosis of urolithiasis in Tikur Anbessa Specialized Teaching Hospital over an eight year period from 2002 to 2010 GC. Data was collected from the records of patients.
Result: A total of 63 children with urolithiasis were admitted to Tikur Anbessa Specialized Teaching Hospital over an eight year period. This accounts to 1 in 121 (0.83%) pediatric surgical ward admissions annually. Among those half of the patients (54%) were in the age range between 5-10 years and 85.7% were males. The major clinical symptoms at first presentation were hematuria (63.5%) recurrent urinary tract infection (60.3%), obstructive symptoms (46.0%), flank pain (42.9%) and family history of urolithiasis was preset in (3.2%). Urine culture was done for 38.1% of the children and 25% of them were positive for E.coli or Klebsiella pneumoniae. Pyuria was present in 47.6% of children. All the stones were visualized by ultrasound, almost half of the stones were found in
the kidneys (53.9%) and bladder (39.7%). Ureteric stones constituted 6.3%. Sixty six point seven percent of the stones were removed surgically and 19.0% passed spontaneously. Extracorporeal Shock Wave Lithotripsy (ECSWL) was used in 14.3% of children. Stone analysis result was found in 15/63 (23.8%) children and Calcium oxalate was the commonest stone constituting 40%, uric acid 13.3%, calcium oxalate and uric acid(20%),and 26.6% were more than 2 types (mixed) stones. There was recurrence of stone in 9.5% of children and 50% recurred after one year of follow up.
Conclusion: Even though the prevalence of urolithiasis in children is low it is not uncommon to see complications like recurrence and renal insufficiency. Any child who presents with hematuria and recurrent urinary tract infection, stone disease has to be ruled out. All stones have to be analyzed and children with stone disease have to be followed even after removal.

Morbidity and Mortality of Neonates Admitted in Jimma University Specialized Hospital Paediatrics Neonatal Ward: A One Year Retrospective Analysis

Habtamu Sime — 2014-01-31

Introduction: The first 4 weeks of life carries one of the highest risks of death of any 4 weeks period in the human lifespan. Reducing Neonatal morbidity and mortality are now a major focus of child health strategies.
Objective: To review the morbidity and mortality pattern of neonates admitted to paediatrics neonatal ward.
Methods: A retrospective study was conducted at Jimma University Specialized Hospital neonatal ward from Jan 2012 to Dec 2012.All neonates admitted to neonatal ward between Jan 2012 to Dec 2012 were included in the study. Card review format was adopted for the purpose of data collection after reviewing relevant literatures. SPSS version 16.0 statistical package was used for data analysis. All statistical tests were performed at the 0.05 level of significance; for logistic regression models, the results were presented using 95% confidence interval odds ratios.
Results: A total of 225 neonates were admitted during the study period, of these 60 % were male, 57.6% of mothers who brought the neonate were from the surrounding district. The main causes of admissions were found to be neonatal infections (40%), low birth weight (32.4 %) and prematurity (30.7%). More than two third of them were hospital deliveries, 78.6% and more than half (55%) of neonates were admitted in the first 24 hours of their life. Regarding the outcome, 78.2% of admitted neonates were improved and discharged and the hospital neonatal mortality rate was 15.9%. None of the neonates diagnosed to have neonatal sepsis had blood culture and sensitivity test. The average length of hospital stay was 9.5 days with SD of 8.2 days. Neonates who were diagnosed to have perinatal asphyxia have increased risk of death [AOR=7.7, (95%C.I:2.49-23.70)]. Weight at admission and perinatal asphyxia were found to have stastically significant association with mortality (p- value <0.05).
Conclusion: Most of the neonates were diagnosed with neonatal infection, prematurity, and Low birth weight. The hospital neonatal death rate seen in this study is high; which indicates the need for improving the quality of neonatal care. Limited laboratory investigations were done for admitted neonates; facility pertaining important investigations including blood culture need to be accessible.

Assessment Of The Outcomes Of Neonates With The Diagnosis Of Esophageal Atresia And/Or Tracheoesophageal Fistula Admitted To Tikur Anbessa Specialized Hospital-Neonatal Intensive Care Unit

MOGES AMARE — 2014-02-01

Background:
Esophageal atresia and/or tracheoesophageal fistula are a fairly common congenital anomaly which is associated with serious morbidity and high rate of mortality in newborns.
Objective:
To assess the outcomes of neonates with the diagnosis of esophageal atresia and/or tracheoesophageal fistula (EA and/or TEF) admitted to Tikur Anbessa Specialized Hospital, Neonatal Intensive Care Unit (TASH-NICU) from Sep., 2008 to Aug., 2013.
Methodology:
This is a retrospective study in which clinical records of all neonates admitted to TASH-NICU with the diagnosis of EA and/or TEF from Sep., 2008 to Aug., 2013 were retrieved and those newborns whose charts had been filled with necessary information were selected as study subjects. A structured questionnaire was used to collect necessary data about each case. Outcome, possible determinant factors of outcome, associated congenital anomalies, treatment provided, and complications were analyzed.
Results:
About 41 cases of EA and/or TEF were admitted to TASH-NICU during the study period. There were 34 eligible cases. Some of the cases whose charts were lost or incompletely filled were excluded from the study. Among the eligible ones, 19 (55.9%) were females and 15 (44.1%) were males. There were only 5(14.7%) newborns that were discharged alive. Most died during the neonatal age (85.3%). Surgical intervention was performed for only half of the cases. Aspiration pneumonia was the most common reason for delayed surgical intervention. It was also the leading cause of respiratory failure and death of the newborns. There was a strong association between mortality and birth weight (P-value < 0.05).
Conclusion
This study showed that most cases of EA and/or TEF admitted to TASH-NICU died during neonatal age. Low birth weight has been strongly associated with higher risk of mortality in neonates with the diagnosis of EA and/or TEF.
Supportive care provided to newborns with EA and/ or TEF was not sufficient as it didn’t include life-saving treatments like mechanical ventilation and total parenteral nutrition.

Survial Of Preterm Infants Admitted To Tikur Anbessa Hospital Nicu, Addis Ababa

Merertu Temesgen — 2014-02-01

Abstract: Neonatal mortality accounts for about 1/3 of deaths < 5 years of age and preterm infant mortality for approximately 1/3 of neonatal mortality. Intervention programs must be based on reliable statistics applicable to the local setting.
Objectives: The objective of this study is to identify factors associated with survival of preterm infants among preterm infants admitted to Tikur Anbessa Hospital Neonatal Intensive Care Unit (NICU). This was a retrospective chart review of 397 preterm infants admitted from July 1, 2011 to June 30, 2012 G.C to the neonatal unit. Overall survival was 69.3% Survival of infants below 28 weeks of GA 40%, survival for infants between 28-31wks of GA is 54.5%, for those between 32-34wks of GA is 74.6% and the survival rate for late preterm infants(35-36+6days) is 100%.GA, birth weight, gender and place of delivery are among the factors associated with survival of preterm infants. This study evidently indicates that the survival rate of preterm infants admitted to TAH is lower than other developing countries that must be improved.