Ethiopian Journal of Health Sciences

COVID-19, a Disease of Enigma

2020-05-11T13:45:49+00:00

Until proved otherwise, Covid-19 or SARS CoV- 2 infection is a disease of the century that turns the world upside down and inside out at multidimensional aspects of human life. Since its emergence, it has created a lot of confusion and uncertainty on its ultrafast speed of spread in the temperate climate zone and the bizarre course of the disease state. The so far relatively spared tropical countries may be explained by the humid and hot weather as it was the case for the majority of influenza and other human coronaviruses pandemics; for which, the less conduciveness of the weather for the survival of the SARS CoV-2 outside the human body may be attributed to. In the interest of this editorial, the less morbid and less fatal nature of the Covid-19 to pregnant women has also opened a lot of discussions and countless speculations. This is because; while their immunity is weaker than non- pregnant women, the high resistance of pregnant women to Covid-19 is a paradox for many investigators.

Why COVID-19 is Less Severe in Pediatric Patients?

2020-08-04T12:25:52+00:00

SARS-CoV-2 is one of seven coronaviruses known to infect humans. Other than SARS-CoV-2, the other coronaviruses causing SARS and MERS are deadly, the rest are relatively benign causing only common colds in the vast majority of cases. SARS-CoV-2 indiscriminately infecting people with varying severity across geographies, genders, and occupations. Despite this indiscriminate attack, experiences and studies indicate that children are mildly affected in comparison to adults, representing approximately 5% of cases and less than 1% of admissions to hospital (1, 2). The proportion of severe and critical cases was 10.6%, 7.3%, 4.2%, 4.1%, and 3.0% for the age group of ˂1, 1-5, 6-10, 11-15 and >15 years, respectively (1). SARS and MERS showed similar pater where kids are largely spared from severe diseases. Swine flu (H1N1) virus, responsible for the flu pandemic of 2009 and 2010 preferentially had tummy symptoms on children.It became mysterious why children are less sick after being infected where more than 90 percent of pediatric cases presenting as moderate, mild, or without symptoms entirely. “Why most of the children’s COVID-19 cases were less severe than adults’ cases is puzzling. Scientists and clinicians need to learn more about this virus and the immune response against it at different age groups. Untying the mystery why SARS-CoV-2 is less severe in children could help to design new ways to combat the spread of the disease.Different literatures forwarded the following ideas to explain why children develop mild COVID-19 disease.1. Vulnerability to ARDS: though small number of cases pass through all phases, COVID-19 disease is having three distinct phases namely the viral phase, the pulmonary phase, and the hyperinflammatory phase. It is during the hyperinflammatory phase cases are likely to develop severe complications like acute respiratory distress syndrome (ARDS). However, studies showed that children are not less prone to developing ARDS during respiratory tract infections; in fact, during the H1N1 flu pandemic, being under the age of one year was a significant risk factor for developing a severe form of ARDS (3,4). Therefore, this argument cannot hold true.2. The immune system’s delicate balance: One of the reasons for the milder COVID-19 disease presentation in children compared to adult may be due to a qualitatively different response to the SARS-CoV2 virus (5). With increasing age, children’s immune systems may reach a sort of just-right status, growing strong enough to keep an infection in check without overreacting.3. Prior Exposure to other similar viruses: children are exposed to various similar viral infection while they are in kindergarten and school. Prior exposure to other milder viruses may contribute for children’s less severe COVID-19 disease. It is shown that disease development and subsequent severity is dose dependent as it is shown in other studies (6). The presence of other viruses in the airways of children could limit the growth of SARS-CoV2 by direct virus-to-virus interactions and competition (7).4. Expression level of Binding Proteins: Similar to that of SARS-CoV-1, SARS-CoV-2 establishes infection by glomming on to a protein called angiotensin-converting enzyme (ACE)2 which is found on the surfaces of cells throughout the body (8). Differences in the expression levels of the ACE-2 receptor between children and adults could contribute for the less severe disease in children. Some researchers have hypothesized that kids’ lung cells could make fewer—or perhaps even differently shaped-ACE2 proteins. This is an example of the fact that the immune systems of children and adults are different, both with respect to their composition and functional responsiveness (9).To note, although children tend to have mild forms of COVID-19, protective measures should be taken to prevent them from becoming infected. This is important for mitigating the pandemic, as not only can children transmit viruses even when presenting mild forms of the disease, but they have been shown to harbour large amounts of the virus even without showing symptoms (10). It is important to remember that viruses can persist in faeces long after they are gone in nasopharyngeal secretions.Understanding the milder COVID-19 disease in children will provide important information about the disease. It may also suggest important protective mechanisms and targets for future therapies.

Why COVID-19 is Less Severe in Pediatric Patients?

2020-09-03T07:32:38+00:00

The Relationship between Patient Safety Climate and Medical Error Reporting Rate among Iranian Hospitals Using a Structural Equation Modeling

2020-05-06T00:16:21+00:00

BACKGROUND: Improving patient safety is a global health imperative, and patient safety climate is one of the components one that plays an important role in promoting patient safety. Medical error reporting is a way through which it can be evaluated and prevented in the future. The aim of this study was to assess the relationship between patient safety climate and medical error reporting in military and civilian hospitals.

METHODS: This research was conducted by using structural equation modeling in the selected hospitals of Iran in 2018. The study community consisted of 200 nurses in the military and 400 nurses in the civilian hospitals. By using Structural Equation Modeling, the relationship between patient safety climate and the rate of medical error reporting in the hospitals was measured by a questionnaire. Data was analyzed using SPSS 17 and LISREL 8.8 software.

RESULTS: The mean score of patient safety climate was moderate in the hospitals. There was no significant relationship between the rate of medical error reporting and patient safety climate, while a significant difference was found between patient safety climate score and age, sex, job category, and type of hospital (P < 0.05).

CONCLUSION: The results suggested that patient safety climate and the rate of reporting errors were not favorable in the studied hospitals, while there was a difference between safety climate dimensions.

Postnatal Care within One Week and Associated Factors among Women Who Gave Birth in Ameya District, Oromia Regional State, Ethiopia, 2018

2020-05-06T00:19:27+00:00

BACKGROUND: Globally recorded large number of maternal and neonatal deaths are related to complications during pregnancy, childbirth and post-partum. Most neonatal deaths occur during the first week of life. It is also evidenced that the level of postnatal care utilization in Ethiopia is very low. This study aimed to assess postnatal care utilization within one week and associated factors among women who had given birth in the last six weeks in Ameya district, Oromia, Ethiopia.

METHODS: Cross sectional study design was employed on 332 study participants who were selected by systemic sampling method and interviewed using structured questionnaires. The data were analyzed using SPSS version 23.0. Bivariate and multivariate logistic regression analysis was used to identify the associated factors with the outcome variable. Figures, tables and sentences were used for the presentation of descriptive statistics.

RESULT: The finding revealed that the proportion of postnatal care utilization within one-week in the study area is 25.3%. Partner occupation[AOR=5.575, 95% CI= (1.071, 29.023)], mothers who had complication during labor and delivery[AOR=7.841, 95% CI= (2.287, 26.879)], distance from mothers to health facilities[AOR= 5.127, 95% CI= (1.149, 22.878)] and awareness on postnatal care within one week services[AOR=4.161, 95% CI= (1.300, 13.314)] were the main contributing factors of postnatal care utilization within one-week.

CONCLUSION: Postnatal care utilization within one-week is very low (25.3%). Partner occupation, complication during labor and delivery, distance from health facilities and awareness on postnatal care within one week service were the associated factors.

Vitamin D Levels in Patients Presenting with Non-Specific Neuromuscular Pain and Fatigue in Ethiopia

2020-05-06T00:21:45+00:00

BACKGROUND: Vitamin D is an important micronutrient impacting multiple physiologic functions including calcium, phosphorus and bone metabolism. Various studies demonstrate low vitamin D levels in non-specific neuromuscular pain disorders and chronic-fatigue-syndromes. This observation was supported by significant improvement of these disorders following Vitamin D supplementation. Several studies demonstrate low serum vitamin D levels in healthy adult Ethiopians despite availability of abundant sunlight.

METHOD: Retrospective medical records review of 62 patients presented to Yehuleshet Specialty Clinic between March 2014- August 2015 with non-specific neuromuscular pain and fatigue. Serum vitamin D levels were obtained at initial clinic visit.

RESULTS: The mean (±SD) age was 51.5 ±15.5 years. Two-third (69.4%) of the participants were female. The majority (56.5%) presented with mixed symptoms, including generalized body ache, paresthesia, neck and back pain, while 45.2% reported fatigue. Fifteen (24.2%) participants were on antiepileptic drugs. All patients had initial serum vitamin D levels < 30 ng/ml, among these 62.9% demonstrated severe deficiency (< 12 ng/ml). Thirty (48.4%) participants reported symptomatic improvement after treatment with standard doses of vitamin D and calcium. Age > 50 years, being housewife, use of antiepileptic medications (AEDs), and higher serum parathyroid hormone are associated with severe vitamin D deficiency.

CONCLUSION: This study demonstrated high prevalence of vitamin D deficiency among patients with non-specific neuromuscular pain and fatigue. Vitamin D replacement resulted in significant clinical improvement. It is important to screen vitamin D in individuals with limited sunlight exposure and patients on AEDs when presenting with neuromuscular pain and fatigue.

Thyroid Hormone Tests Ordering Practice and Cost-Effectiveness in Samples Referred to International Clinical Laboratories from Addis Ababa Health Facilities

2020-05-06T00:27:26+00:00

BACKGROUND: Thyroid dysfunction accounts for majority of endocrine disorders. In sub-Saharan Africa Graves’ disease and hypothyroidism have accounted for 13.1% and 8.8% while the burden of thyroid disorder has ranged from 6.18 to47.34% among countries in the Arab world. The cost for a primary thyroid test done to evaluate the gland function constituted a large proportion of the public health budget. For instance, 10 million thyroid functions have been done each year by laboratories which cost 30 million UK pounds, and they represent 8% of laboratory charge in the US. When a TSH-only protocol (guideline) was used, 95% of the requests were sufficient for diagnosis without requiring further tests, thereby resulting in 50% savings on FT4 reagent and reducing the annual TFT reagent cost by 25%. This is an original study, and its objective was to assess the ordering pattern of TSH tests and their cost-effectiveness in patients’ samples referred to ICL from Addis Ababa health facilities between July2015 to June 2016

METHOD: An institution-based cross-sectional study design was utilized to study the ordering pattern of thyroid function tests using one-year retrospective data from ICL.

RESULTS: Thyroid profiles were ordered more frequently (49.5%) compared to TSH only (24.3%). An additional 2625.70 USD was paid by patients for individual components in the profile tests that turned out normal.

CONCLUSION: Guidelines advocate TSH as the initial test for thyroid dysfunction, but the use of a combination of tests is more common.

Participants' Opinion about Conduct of Morbidity and Mortality Conferences in Surgical Practice in a Tertiary Hospital, Ethiopia

2020-05-06T00:32:00+00:00

BACKGROUND: Morbidity and mortality conference has both educational and quality improvement purposes. However clear evidences for the effectiveness of the morbidity and mortality conferences in improving patient safety is lacking.

METHODS: A facility based cross sectional study was conducted at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, to assess participants’ opinion on benefits and functioning of morbidity and mortality conferences. Univariate analysis was used to determine the influence of professional type on participants’ opinion about the morbidity and mortality conferences.

RESULT: A total of 98 participants completed the survey. The majority of the participants agreed that there was a structured system of case identification (67.3%), meeting format (72.4%), the conferences were conducted every month (79.6%), it is blame free (71.4%) and system of care was focus of discussion (70%). Most (88.8%) participants agreed that the conferences were important for improvement of patient safety and quality of care, whereas 67.3% of the participants believed that there is no written term of reference and prior dissemination of agendas. Only 40% agreed that there is multidisciplinary team involvement. Fifty one percent of them disagreed that there is a follow up on the implementation of the forwarded recommendations.

CONCLUSION: Even though the majority of the participants were satisfied with the mortality and morbidity conferences, most disagreed on the presence of written term of reference, earlier dissemination of agendas, multidisciplinary team involvement and follow up on the implementation of the forwarded recommendations.

Perforated Peptic Ulcer Disease in a Tertiary Hospital, Addis Ababa, Ethiopia

2020-05-06T00:35:13+00:00

BACKGROUND: Peptic ulcer perforation is one of the two major acute complications of peptic ulcer disease with significant morbidity and mortality.

METHODS: Institution based retrospective review was done to determine patient presentation, management and postoperative complications of perforated peptic ulcer disease (PPUD) at a tertiary hospital in Addis Ababa, Ethiopia. Patients operated on from January 2013 to December 2017 were included. Univalent analysis was used to determine the influence of patient and operative events on postoperative outcomes.

RESULT: Totally, 136 patients were studied. Males outnumbered females by a ratio of 5.5:1. The mean age of patients was 36.05±16.56 years. Seventy-one (52.2%) patients presented after twenty-four hours of onset of symptoms. Most perforations were located on the first part of the duodenum (117,86%). There were 73 postoperative complications recorded in 31(22.8%) patients. Old age, being female, presence of comorbidity, hypotension, tachycardia, and delayed presentation were significantly associated with postoperative morbidity (P<0.05). Nine (6.6%) patients died at the hospital. Mortality was significantly associated with old age, comorbid illness, tachycardia, and development of post-operative complications (P<0.05). The postoperative hospital stay of the patients with complications was 18.6 ± 14.7 days which was significantly higher than that of patients without complication 6.7±2.7days (P=0.001).

CONCLUSION: Old age, being female, presence of comorbidity, hypotension, tachycardia, and delayed presentation were significantly associated with postoperative morbidity. Old age, comorbid illness, tachycardia and development of post-operative complications were found to increase the risk of mortality.

Magnitude and Pattern of Inpatient Surgical Mortality in a Tertiary Hospital in Addis Ababa, Ethiopia

2020-05-06T00:42:03+00:00

BACKGROUND: Inpatient mortality is among regularly collected data in Key performance indicators in the Ethiopian healthcare system, and it is generally reported to the Federal Ministry of Health and is used as one of inpatient services quality indicators. This study was undertaken to identify the magnitude, causes and pattern of mortalities among patients who are admitted and treated in surgical wards in Saint Paul Hospital Millennium Medical College for a period of three years.

METHODS: A retrospective review was done on all patients admitted and died in the Department of Surgery in St. Paul's Hospital Millennium Medical College from January 1, 2016–Dec 30, 2018.

RESULT: There were 10,259 admissions over three years and out of which there were 350 deaths between 2016-2018 making a crude mortality rate of 3.41 %. The commonest mode of admission was for emergency conditions, 195(62.7%). Out of emergency admissions, 139 mortalities were from general emergency surgery and 75 patients died from elective general surgery admissions. Eighty-four (26.9%) patients had comorbidity and the commonest comorbidity was anemia 21(25%). The commonest possible cause of death was multi-organ failure secondary to septic shock, 159(51%). Mortality rate patterns along the three years (2016, 2017, 2018) showed 3.34% (112/3360), 2.87% (102/3552) and 2.92% (98/3347) respectively.

CONCLUSION: The mortality rate of this study is much higher than global rates, but still there is a significant difference from other developing countries and also other researches in this country. Pattern of mortality did not show any difference across years of the study period.

Willingness of Family Caregivers to Consent to Relative’s Postmortem Examination that Die Suddenly in a Nigerian Tertiary Hospital

2020-05-06T00:56:38+00:00

BACKGROUND: Postmortem examination is necessary to diagnose the cause of sudden death, and family caregivers are expected to consent to this examination. This study assessed knowledge, attitude, practices and willingness of family caregivers to consent to postmortem examination of their relative if they die suddenly in a Nigerian tertiary hospital.

METHODS: Descriptive cross-sectional study of family caregivers of our patients that completed an interviewer administered semi- structured questionnaire assessing their knowledge, attitude, practices and willingness to consent to postmortem examination of their relative if they die suddenly. Data were analyzed using descriptive and inferential statistics.

RESULTS: A total of 224 caregivers were interviewed. The mean age (SD) was 34.95 (11.74), ranging 22-75 years. They were parents (32.6%), siblings (37.9%), spouses (11.2%) and other relatives (18.3%). Only 17% had adequate knowledge, 44.6% positive attitude and 11.2% good practices to postmortem examination of sudden death. The majority (75.9%) would consent to postmortem examination of their relatives if they die suddenly. Sociodemographic variables associated with willingness to consent to postmortem examination after relative’s sudden death include being male (AOR 3.61; 95%CI 3.09-8.92; p=0.001), having tertiary education (AOR 4.83; 95%CI 1.01-8.29; p=0.034), Christianity (AOR 2.59; 95%CI 1.25-5.35; p=0.010) and skilled worker (AOR 1.43; 95%CI 1.33-3.80; p=0.020).

CONCLUSION: Some family caregivers would not consent to postmortem examination of their relatives when they die suddenly. Sensitization programs targeting family caregivers are necessary to increase knowledge and enhance prevention of sudden death as well as improve willingness to consent to postmortem examination when their relatives die suddenly.

Age-Related Histological Changes in Vena Caval System of Human Foetus and Adult

2020-05-06T01:08:45+00:00

BACKGROUND: It has been documented that cardiac musculature is present in both venae cavae, and they contract together with the atrium, contributing to the pumping mechanism of the heart. So, in the present study, we measured the relative thicknesses of the three histological layers at formation, termination and intermediate levels of the venae cavae along with their histological characteristics.

MATERIALS AND METHODS: Ten foetal and 10 adult cadavers were used. The Superior and Inferior Venae Cavae from all three regions were excised and processed for histology. The qualitative and quantitative features of the vessels were observed and recorded. The data thus obtained was then assessed statistically.

RESULTS: In superior vena cava, the tunica intima grows actively especially during late gestation. The tunica media shows active growth. The tunica adventitia growth is significant at the middle and termination levels. In inferior vena cava, the tunica intima grows actively at the level of formation. The tunica media shows the active overall growth during early gestation. The tunica adventitia shows active growth during late gestation. In qualitative analysis the plump, spindle-shaped primitive mesenchymal cells were observed. Muscle and collagen fibers show reciprocal abundance with increasing age, with the former being lesser in amount than the latter in earlier stages. Appearance of vasa vasorum was notable from 2nd trimester. The cardiac myocytes were located in the middle and outer tunics of the superior vena cava.

CONCLUSION: Cardiac musculature was absent in the inferior vena; however, the vessel shows advanced rate of overall development.

Seroprevalence and Trend of HBV, HCV, and HIV Infections among Blood Donors of Fars Province, Iran (2006-2018)

2020-05-06T01:20:03+00:00

BACKGROUND: Blood transfusion is a life-saving procedure; millions of lives are saved each year. However, blood transfusions are associated with certain risks that can lead to adverse consequences. This study aimed to survey the prevalence and trend of hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV) among blood donors of Fars province, Iran (2006-2018).

METHODS: This retrospective cross-sectional study was conducted by reviewing the records of the blood transfusion organization of Fars province. A total of 1952478 blood units were screened for transfusion-transmitted infections (TTIs). Then, data were entered into SPSS software (Negare. version 25). Chi-square test was used to compare the sof TTIs among blood donors. Chi- square test for trend was used to analyze the variations in trends of TTIs during this period. Finally, p-values less than 0.05 were considered statistically significant. GraphPad Prism software was used for the depiction of the graphs.

RESULTS: Among the 1952478 blood donations within the 13- years, 4479(0.229 %) of donors were HBsAg, HCV Ab, and HIV Ag-Ab positive. The seroprevalence of HBV, HCV, and HIV was 2684(0.137%), 1703(0.087 %), and 92(0.0047%), respectively.

CONCLUSION: The current study showed that the overall prevalence of TTIs among blood donors was low and had a descending trend over the years of study.

Real-Life Incentives Driving Public-Private Partnership in Diagnostic Services

2020-05-06T04:32:35+00:00

BACKGROUND: Diagnostic services are highly critical in the success of treatment processes, overly costly nonetheless. Accordingly, hospitals generally seek the private partnership in the provision of such services. This study intends to explore the incentives owned by both public and private sector in their joint provision of diagnostic services under the public-private partnership agreement.

METHOD: A qualitative, exploratory study was employed in Tehran hospitals from October 2017 to March 2018. Around 25 face-to-face, semi-structured interviews were conducted with the purposively recruited hospital managers, heads of diagnostic services and managers of private companies. Interviews were transcribed and analyzed using conventional content analysis, assisted by "MAXQDA-12".

RESULTS: Three main categories and nine sub-categories represented the incentives of public sector, and four main categories and seven sub-categories signified those of private sector. The incentives of public sector included the status-quo remediation, upstream requirements, and personal reasons. As such, the individual, social and economic incentives and legal constraints were driving the behavior of the private sector.

CONCLUSIONS: Financial problem and gain were the most noted incentives by the partners. Attention to the either side’s incentives and aims is likely to ensure the durability and effectiveness of such partnerships in the health sector.

Experience and Challenges of Objective Structured Clinical Examination (OSCE)

2020-05-06T04:37:27+00:00

BACKGROUND: Invented nearly half a century ago, Objective Structured Clinical Examination (OSCE) is overwhelmingly accepted clinical skills assessment tool and has been used worldwide for evaluating and teaching learners’ competences in health care disciplines. Regardless of factors affecting the attributes, OSCE is considered as reliable and powerful tool with certain validity evidences. In spite of its advantages and various promotion efforts, the progress of OSCE implementation in Ethiopian public universities has not been satisfactory. Therefore, the objective of this study was to explore the experience and challenges of OSCE implementation from the perspective of clinical year-II medical students and their examiners in Ob-Gyn Department of Jimma University.

METHODS: Forty-nine students and seven examiners voluntarily participated in Ob-Gyn Department where OSCE has been used as one of summative assessment methods. Qualitative study design using structured open-ended questionnaire as a tool and descriptive phenomenology as underpinning method were employed. Collaizzi’s descriptive analysis was used as phenomenological analysis approach.

RESULT: Poor organization, inadequate student preparation time, and inadequate number and duration of stations were thematically emerged as umbrellas of factors negatively affecting OSCE implementation. Satisfaction with OSCE was the only theme with findings that encourage OSCE implementation.

CONCLUSION: There should be team approach, shared responsibility and proper planning among faculty to minimize hindering factors of OSCE implementation. Besides faculty development on OSCE, the department should improve skill lab utilization arranging schedule for both students and faculty members to increase guided students’ exposure to simulation-based learning and ultimately enhance OSCE implementation.

Will Africa be Devastated by Covid-19 as Many Predicted? Perspective and Prospective

2020-05-06T00:16:12+00:00

ince the novel coronavirus disease 2019 (Covid-19 or SARS CoV-2 infection) has been declared as pandemic, several mathematicians and statisticians have developed different trajectory curves for Africa, with the assumption that the virus can have an exponential pattern of transmission. According to Economic Commission for Africa, 300k-3.3 million COVID-19 related deaths may occur in Africa (1). A large body of literature and international media have also predicted that Africa is going to be flooded, much higher than Europe and the United States of America (USA). For Ethiopia alone, some estimated 28-33 million with full mitigation and 70-107 million people without mitigation actions can get infected. When the author of this perspective sees such an easy to do, but hard to conceive figures, he likes to join the closed loop forum and express what his thought is.

The Effectiveness of Aromatherapy in the Management of Labor Pain and Anxiety

2020-05-06T00:26:13+00:00

BACKGROUND: Aromatherapy as an alternative and complementary medicine is a well-known method for reducing the symptoms of various physiological processes such as labor experience. The aim of this study was to systematically review the currently available evidences evaluating the use of aromatherapy for management of labor pain and anxiety.METHODS: In a systematic review, 5 databases (PubMed, SCOPUS, Web of Science, Google Scholar and Scientific Information Database [SID])were searched, from database inception up to December 2019.Keywords used included (aromatherapy OR "“essential oil” OR "aroma*") AND (pain OR anxiety) AND (laborOR delivery). Using the Cochrane Collaboration's 'Risk of bias' method; the risk of bias in the included studies was evaluated.RESULTS: A total of 33 studies were verified to meet our inclusion criteria. Most of the included studies wereconducted in Iran. Aromatherapy was applied using inhalation, massage, footbath, birthing pool, acupressure, and compress. The most popularly used essential oil in the studies was lavender (13 studies), either as a single essential oil or in a combination with other essential oils. Most of included studies confirmed the positive effect of aromatherapy in reducing labor pain and anxiety.CONCLUSION: The evidences from this study suggest that aromatherapy, as a complementary and alternative modality, can help in relieving maternal anxiety and pain during labor.

Retrospective Policy Analysis of Tobacco Prevention and Control in Ethiopia

2020-05-06T04:43:27+00:00

BACKGROUND: The trend of non-communicable diseases is alarmingly increasing and tobacco consumption and exposure to its smoke have been playing the leading role. Thirty-seven Ethiopians deaths per day are attributable to tobacco. Unless appropriately mitigated, this has social, economic and political impacts. Implementation of the appropriate policy is a good remedy; however, the policy process has never been straight forward and always successful. The involvement of different actors makes policy process complex hence agenda setting, policy formulation, implementation, and evaluations have been full of chaos and even may fail at any of these levels. Thus the aim of this review was retrospectively analyzing tobacco-related policies in Ethiopia that are relevant to control tobacco use and mitigate its impacts.

METHODS: Systematically, we searched in pub-med, Scopus, Web of Science and Embase. Additionally, we did hand search on Google scholar and national websites. The terms "tobacco", "cigar", "cigarette", "control", "prevention", "policy" and "Ethiopia" were used. Eleven of 128 records met the inclusion criteria and then included. For data analysis, we applied the health policy analysis framework developed by Walt and Gilson.

RESULT: Lately, Ethiopia enacted and started to implement tobacco control policies and programs, but its implementation is problematic and consumption rate is increasing.

CONCLUSION: Despite the early involvement in tobacco control initiatives and enactment of legal frameworks, Ethiopia's journey and current stand to prevent and control the devastating consequences of tobacco is very limited and unsatisfactory. Therefore, we strongly call for further action, strong involvement of private sector and non-governmental organizations.

Prevalence Rate of Diabetes and Hypertension in Disaster-Exposed Populations

2020-05-06T04:47:59+00:00

BACKGROUND: Non-communicable diseases (NCD) such as hypertension (HTN) and diabetes mellitus (DM) have been one of the major health problems in the world. The aim of this study was to evaluate the prevalence rate of DM and HTN following natural and man-made disasters that impose significant economic and psychological burdens on human communities.

METHODS: In this systematic and meta-analysis review, all cross- sectional studies that at least one of their objectives was to measure the prevalence of HTN or DM in individuals affected by natural and man-made disasters were included. Literature review was done in international databases including PubMed, Scopus and Web of Science, from database inception to February 17, 2019. The extracted data included the bibliographic characteristics of the article, the age of the participants, number of participants, gender, sample size, outcome, duration of the follow-up, and prevalence of DM and HTN. Data were analyzed by STATA software (version11) and random effect method and the I2 index were used to investigate heterogeneity between the articles.

RESULTS: A total of 16 articles met the inclusion criteria. Based on the quality assessment, 11 papers were categorized as moderate and 5 paper were categorized as high quality. The prevalence of HTN and DM in disaster-exposed populations were 47.35 (CI 95%: 38.53-56.17) and 13.56 (CI 95%: 10.12-17.01), respectively.

CONCLUSION: The results of this study show a high prevalence of HTN and DM in survivors of major disasters, which is higher in comparison to the general population