Ethiopian Journal of Health Sciences

Table of content

Yibeltal Siraneh — 2022-11-01

Table of the content

Editorial message

Abraham Haileamlak — 2022-11-01

Message from the Editor-in-chief.

COVID-19 Vaccine Hesitancy and its Reasons in Addis Ababa, Ethiopia: A Cross-Sectional Study

Tamrat Assefa Tadesse — 2022-11-01

BACKGROUND: Coronavirus disease (COVID-19) vaccine hesitancy becomes the major bottleneck to the global healthcare system in minimizing the spread of the virus. This study aimed at assessing COVID-19 vaccine hesitancy and its reasons among residents of Addis Ababa, Ethiopia.

METHODS: A community-based cross-sectional survey was conducted between May 16 to 29, 2021 in purposively selected four districts of Addis Ababa, Ethiopia. A structured questionnaire was developed and then designed on Google Forms platforms to collect data from study participants after obtaining a verbal consent form. A total of 422 study participants were included in the survey. Data were entered into Microsoft Excel and then exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis.

RESULTS: Face masks and alcohol hand rub/ sanitizer are used by 50. 7 and 24.9% of respondents when required. COVID-19 was thought to have been generated by humans by a substantial percentage of study participants (38.2%). About half (50.7%) and 24.9% of respondents use face masks and alcohol hand rub/sanitizer always when it is required, respectively. A large number of study participants (38.2%) believed that origin of COVID-19 is man-made. Overall, 242 (57.4%) of study participants reported COVID-19 vaccine hesitancy. Fear of vaccine side effects (49.6%) was the most common reason for hesitancy. Doubt about its effectiveness (33.9%), not having enough information about the COVID-19 vaccine, preferring another way of protection, and unreliable of the vaccine (due to its short development period) were also the most frequently mentioned reasons for not receiving the COVID-19 vaccine.

CONCLUSIONS: COVID-19 vaccine hesitancy rate was high in Addis Ababa, Ethiopia during the study period. Fear of side effects, doubts about its effectiveness, and not having enough information about the COVID-19 vaccine were major reasons for hesitancy. Continuous awareness creation to the community on the importance of vaccination is warranted by health professionals and healthcare cadres.

Household Readiness to Care for Mild and Asymptomatic COVID-19 Cases at Home, Southwest Ethiopia: A Community-based Cross-Sectional Study

Lelisa Sena Dadi — 2021-11-01

BACKGROUND: Corona virus disease (COVID-19) continued with its notorious effects overwhelming health institutions. Thus, home-based identification and care for asymptomatic and mild cases of COVID-19 has been recommended. Therefore, the objective of this study was to assess the level of household readiness for caring asymptomatic and mild cases of COVID-19 at home.

METHODS: A community-based cross-sectional study was conducted from March-June 2021 on randomly selected 778 households. Data entry and analysis were carried out using EpiData and SPSS version 25, respectively. Multivariable logistic regression was modeled to identify independent predictors of community readiness.

RESULTS: Overall readiness of the community was very low (43.8%). Factors positively affecting household readiness were male household heads (AOR = 1.6; 95%CI: 1.05, 2.45), primary (AOR=2.0; CI:.62, 1.59) and higher (AOR = 1.90; 95%CI: 1.04, 3.45) educational level of the respondents, number of rooms within household (AOR = 1.22; CI: 1.03, 1.46), having additionally house (AOR = 2.61; CI: 1.35, 5.03), availability of single use eating utensils (AOR = 2.76; 95%CI: 1.66, 4.56), availability of community water supply (AOR = 8.21; 95% CI: 5.02, 13.43), and community participation and engagement (AOR = 2.81; 95% CI: 1.93, 4.08) in accessing transport, water and sanitation.

CONCLUSIONS: The community was less prepared in terms of housing, infection prevention, water and sanitation. Considering alternative options including universal coverage of vaccine is important; designed behavioral change communications can enhance community participation and engagement in improving access to transport, water and sanitation to reduce risk of infections.

Effect of the COVID-19 Vaccine on the Menstrual Cycle among Females in Saudi Arabia

Fadi S. I. Qashqari — 2022-11-01

BACKGROUND: The number of reports of menstrual changes after COVID-19 vaccination in the Saudi population is still unknown. Therefore, this study aimed to assess the effect of the COVID-19 vaccine(Pfizer, AstraZeneca, and Moderna) on the menstrual cycle among females in Saudi Arabia.

METHODS: This descriptive cross-sectional study was conducted in Saudi Arabia at Umm Al-Qura University (UQU) from August 2021 to February 2022. Data was collected through a previously validated online questionnaire.

RESULTS: A total of 2338 participants who received the first dose of the COVID-19 vaccine participated in this study; 1606 (68.7%) of them received the second dose in addition to the first. The mean age of the study participants was 35.4±9.5 years. No significant associations were found between the type of COVID-19 vaccine and the impact on the menstrual cycle, either for the first or second dose (P-values > 0.05). A significant association was found only between the first dose vaccination day and the impact on the menstrual cycle in the second question of “After receiving the COVID-19 vaccine, your next period was” (P-value ≤ 0.05). Significant associations were found between the second dose vaccination day and the impact on the menstrual cycle in the first and second questions of “After receiving the COVID-19 vaccine, your next period was”, and “After receiving the first dose, your next period was," respectively (P-values ≤ 0.05).

CONCLUSION: The study found a potential association between the COVID-19 vaccine and menstrual cycle irregularities, which could impact females' quality of life.

The Status of Facility Based Emergency Care in Public Hospitals of Ethiopia Using WHO Assessment Tool

Menbeu Sultan — 2022-11-01

BACKGROUND: The availability of emergency care contributes to half of the total mortality burden in a low and middle income countries. The significant proportion of emergency departments in LMICs are understaffed and poorly equipped. The purpose of this study is to examine the status of emergency units and to describe the facilitators and barriers to the provision of facility-based emergency care at selected Ethiopian public hospitals.

METHODS: A mixed-methods explanatory design was used. Ten hospitals were purposively selected due to their high number of patients and referral service. A WHO facility assessment tool was used to quantitatively assess the facilities, and an in-depth interview with hospital and emergency room leadership was conducted. The quantitative results were descriptively analyzed, and the qualitative data was thematically analyzed.

RESULT: This survey included a total of ten hospitals. Three of the facilities were general hospitals, and seven were tertiary level hospitals. They all were equipped with an emergency room. All of the studied hospitals serve a population of over one million people. In terms of infrastructure, only 3/10 (30%) have adequate water supply, and alf (5/10) have telephone access in their ED. The qualitative resultshowedthat the most common barriers to emergency care delivery were prolonged patient stays in the emergency room, inadequate equipment, and a shortage of trained professionals.

CONCLUSION: The status of emergency care in Ethiopia is still developing, and hospital care as a whole should improve to alleviate the high burden of care in emergency rooms and reduce morbidity and mortality.

Assessment of Adult’s Abdominopelvic Computed Tomography Radiation Doses in Amhara Region, Ethiopia

Seife Teferi Dellie — 2022-11-01

BACKGROUND: Computed Tomography plays a priceless role for diagnostic and therapeutic purpose; however, applying an optimized Computed Tomography Technique to produce qualified image while delivering minimum radiation dose to patients is the common challenge. The main objective of this study was to establish local diagnostic reference levels for adult patients who visited abdominopelvic Computed Tomography examination.

METHODS: A total of 158 patients who had taken abdominopelvic Computed Tomography examination from three selectedAmhara region hospitals were investigated. Both prospective and retrospective techniques of data collection were used while collecting the data in the entire sample. Two GE - Optima Computed Tomography 540 (16 slices) and one Phillips – Brilliance (64slices), were employed during data collections. Data for patient demographics scan protocols, Computed Tomography dose descriptors and machine specifications were collected and analyzed by using SPSS software version 26.

RESULTS: The third quartile estimated computed tomography dose index volume and dose length product, which is the local Diagnostic Reference Levels, were 12 mGy and 1904 cm.mGy respectively. The investigated local Diagnostic Reference Levels of Computed Tomography Dose index volume (mGy) was comparable to other international Diagnostic Reference Levels. However, the third quartile value of dose length product (cm.mGy) was higher than other reported international Diagnostic Reference Levels.

CONCLUSION: The values of local Diagnostic Reference Levels presented in this work can be used as a baseline upon which future dose measurements can be compared in Amhara region.

Time to Discharge and its Predictors among Children Aged 1-60 Months with Severe Acute Malnutrition Admitted to the Therapeutic Feeding Center in A Tertiary Hospital, North West Ethiopia

Mehretie Kokeb — 2022-11-01

BACKGROUND: Standard treatment of severe acute malnutrition with medical complication and/or failed appetite test is admission in therapeutic feeding centers for stabilization. Once stabilized, patients will be linked to Outpatient treatment program for rehabilitation. Information regarding time to discharge from inpatient therapeutic feeding centers is limited in Ethiopia. The main objective of this study was to assess the time to discharge and its predictors among children1-60 months with Severe Acute Malnutrition admitted to University of Gondar Hospital.

METHODS: Hospital Based retrospective follow up study was conducted in Gondar University Hospital among 282 children aged 1-60 months admitted to inpatient Therapeutic Feeding Center from June 2018 to December 2020. Participants were selected by Simple random sampling technique. Time to discharge from inpatient treatment was estimated using Kaplan-Meir procedure and Log Rank test was used to test observed difference between covariates. Identification of predictors for time to discharge was done by Stratified cox regression model.

RESULTS: Overall 282 children were studied; 242 (85.8%) were discharged improved and 40 (14.2%) were censored. The median time to Discharge was 13 days (IQR: 9-18) and the Incidence of discharge was found to be 6.4 (95% CI: 5.6-7.2) per 100 person- day observations. Kwash-dermatosis (AHR=2.4, 95% CI: 1.17-4.8), Anemia (AHR=1.7, 95% CI: 1.1-2.6), pneumonia at admission (AHR=1.6, 95% CI: 1.01-2.63) and Hospital acquired infection (AHR=4.4, 95% CI: 2.4-8.2) were predictors of time to discharge.

CONCLUSION: Hospital stay at the stabilization center was prolonged. Pneumonia, anemia, kwash dermatosis and Nosocomial infections were significant predictors of time to discharge.

Practice of Postoperative Pain Management in Under-Five Children in A Tertiary Hospital: A Prospective Crossectional Study

Belachew Dejene Wondemagegnehu — 2022-11-01

BACKGROUND: Despite advancements in pain management, children have remained undertreated for postoperative pain. Data regarding the practice of post-operative pain management in paediatric patients remains less available in the developing world. This study was aimed at evaluating practice of postoperative pain management in under five children.

METHODS: A prospective cross sectional one-year study was conducted on all paediatric patients who underwent major paediatric surgical procedures from February 1, 2020 to January31, 2021, at a tertiary hospital in Addis Ababa, Ethiopia.

RESULT: A single type of analgesic medication was used in 67.1% patients. Analgesic medications were administered on standing base only in 64.4% of patients. Patients’ charts had no documentation of pain assessment both in the neonatal intensive care units and wards.32.89 % of assessed patients had moderate to severe pain record.

CONCLUSION: Significant number of patients suffer from post-operative pain because of absence of proper pain assessment and inadequate administration of analgesic medication.

Postnatal Care Utilization and Associated Factors among Mothers who gave Birth in the Aysaeta District, Northeast Ethiopia: A Community Based Cross-sectional Study

Mohammed Ahmed Ibrahim — 2022-11-01

BACKGROUND: Postnatal care is given to mothers and newborn babies within 42 days of delivery. It is a period of high maternal and newborn mortality and is also the most neglected in terms of maternal health services in many parts of the world. This study aimed to assess postnatal care and associated factors among mothers who gave birth in the year preceding the survey of the Ayssaeta district.

METHODS: A community-based cross-sectional study was conducted among 406 mothers who gave birth in the year preceding the survey from August 02–30, 2020. Bivariable and multivariable logistic regression analyses were done to identify factors associated with postnatal care utilization.

RESULTS: Slightly greater than four out of ten mothers have visited postnatal care units at least once. Living in urban areas, giving birth in a health facility, having complications during labor and after, and getting advice during antenatal care visits were associated with higher odds of postnatal care utilization.

CONCLUSION: Less than half of the mothers received postnatal care following the delivery of their last child. Living in an urban, place of delivery, experiencing labor and postpartum complications, and receiving postnatal care advice during antenatal care have affected the utilization of postnatal care. Promoting skilled delivery and antenatal care with a focus on rural areas can help mothers learn about postnatal care and increase the number of mothers who use it.

One Side Ovarian Rejuvenation: A Quasi-Experimental Study of the Effect of the Autologous Platelet Rich Plasma in Poor Ovarian Responders in IVF

Fatemeh Keikha — 2022-11-01

BACKGROUND: The poor ovarian response is the most important limiting factor in the success of in vitro fertilization (IVF). The aim of this study was to evaluate the outcome of intraovarian injection of autologous platelet-rich plasma (aPRP) on the oocyte number and IVF outcomes in poor ovarian responders (POR).

METHODS: This quasi-experimental study was performed from August 2021 to December 2021, in Vali-e-Asr Infertility Clinic affiliated with Tehran University of Medical Sciences, Tehran, Iran. There were 12 POR patients selected based on the criteria of Bologna group 4 who underwent two IVF cycles with similar antagonist regimens in a 70-day-interval. Immediately after the Oocytes Pick-Up (OPU), there was a 4cc of autologous PRP multifocal intramedullary injection done into their right ovaries in the first IVF cycle (case group). On the other hand, their left ovaries were considered as the control group. The patients underwent the second IVF cycle after 70 days.

RESULTS: Those who had undergone aPRP experienced a significant increase of the mean of antral follicular count (AFC) (from 1.91±0.79 to 2.50±0.90, p=0.043). There was a significant increase in the number of embryos from the right ovary (intervention group) compared to the left ovary (control group) after PRP, but there was no significant difference in the number of embryos in the right ovary before and after the intervention (from 0.25 ±0.45 to 1.08±0.79, p=0.705). There was no significant change in the number of oocytes, AMH, and FSH in the case and control groups before and after the intervention (p>0.05).

CONCLUSION: According to the results of this study, it seems that in females with POR, intraovarian aPRP had no effect on the outcomes (embryos number, number of oocytes, FSH and AMH level), except for an increase in AFC.

Development and Validation of a Tool to Assess the Knowledge, Attitude and Perception of Women Towards Screening Mammography

Priyanka Chandrasekhar — 2022-11-01

BACKGROUND: Breast cancer is a major public health concern in both developing and developed countries. The mortality rate of breast cancer is high in India due to late detection, and lack of knowledge about the screening mammography. The objective of this study was to develop and establish the psychometric properties of the tool.

METHOD: A qualitative method was used to carry out the development and validation of a tool to assess the knowledge, attitude, and perception of women towards screening mammography using a cross-sectional study design. Data analyzed using the SPSS 16 were descriptive, and Cronbach's alpha coefficient was used to standardize the tool.

RESULTS: The pilot test, content validity, and internal consistency reliability of the final 25 items were found to be highly adequate. Intra- class correlations of this questionnaire were considered acceptable. Cronbach’s alpha score was 0.825.

CONCLUSION: A valid scale has been developed to evaluate the knowledge, attitude, and perception of women toward screening mammography. The scale is adequately responsive to test the knowledge and possesses strong internal consistency. Lack of knowledge among the general population about the screening mammography. It is recommended to conduct an educational program to enhance knowledge about screening mammography. The questionnaires can be used for evaluating the knowledge, attitude, and perception of women toward screening mammography. Broadening the concept for further questionnaires tool development of knowledge, attitude, and perception of women towards screening mammography in other geographical areas.

Spiritual Experiences of Patients in the Cancer Trajectory: A Content Analysis

Mahboobeh Khosravani — 2022-11-01

BACKGROUND: Introduction: Patients with cancer as a life-threatening illness have needs in various dimensions. One of the most crucial dimension is spiritually. The present study was conducted to elucidate the spiritual needs of patients with cancer.

METHODS: A qualitative approach involving face to face semi-structured interviews conducted in Arak city, Iran. In total, 24 participants were recruited through purposive sampling. All interviews were recorded and transcribed verbatim. The data were analyzed using content analysis.

RESULTS: Patients' experiences of spirituality were classified into four themes, including spiritual needs (need to be in nature, need to communicate with others, need to perform religious practices, need for solitude and reflections, need to trust and security), strategies to address spiritual needs (physical activity, achieving inner peace, communication with the nurse or physician, doing dhikr (Zikr) and pray, reading the religious book and texts, making vows, paying attention to and loving others), reasons for not using spiritual resources (lack of belief in the healing powers of praying, believing in a better life after death), and impacts of spiritual beliefs (hope of Life, belief in divine destiny, trusting in God’s support, accepting the divine test).

CONCLUSION: Exploring the experiences, perceptions, and spiritual needs of cancer patients is of great importance in providing spiritual care as one of the critical aspects of holistic care. Nurses should be educated for assessing spiritual needs of patients to provide spiritual care.

The Association between Colorectal Cancer and Colonoscopic Conditions in Saudi Patients: A 10-Year Cross-Sectional-Retrospective Study

Samah Alharbi — 2022-11-01

BACKGROUND: In Saudi Arabia, colorectal cancer (CRC) is the most common cancer in males and the third most common cancer in females. The current gold standard for colorectal cancer diagnosis is colonoscopy. Several concerns regarding the balance of ordering colonoscopy procedures for patients presenting with signs and symptoms. There are also several concerns regarding over-ordering the procedure when unnecessary. The current study aimed to evaluate the association between colorectal cancer and colonoscopic conditions in Saudi patients.

METHODS: A 10-year cross-sectional study was conducted at Alnoor Specialty Hospital, Makkah, over the last ten years. Colonoscopy reports of patients were evaluated to identify the colonoscopy manifestations associated with mass, polyps, and bleeding.

RESULTS: The current study evaluated 2158 cases admitted to the hospital for colonoscopic diagnosis. Results indicated that most of the patients were males (55.4%). Additionally, results showed a significant statistical association between tumor and bleeding, polyp, and hemorrhage. Moreover, it highlighted the association between polyps and bleeding, inflammation, and diverticulosis.

CONCLUSION: CRC screening in Saudi Arabia is comprehensive; however, there are a few areas for improvement, including standardization of colorectal cancer pathology reporting to improve the health system's quality. Also, the current study identified conditions that are significantly associated with reported colon polyps and tumors, which could aid in stratifying patients selected for screening via colonoscopy.

Frequency and Factors Associated with Orthostatic Hypotension in Individuals with Parkinson’s Disease: A Case-Control Observational Study

Abenet Tafesse Mengesha — 2022-11-01

BACKGROUND: Orthostatic hypotension (OH) is a common and considered the most incapacitating non-motor symptom of Parkinson’s disease (PD). Little is known about OH in Ethiopian PD patients. The objectives of the present study were to determine the frequency and factors associated with OH in individuals diagnosed with PD compared to a healthy control.

Methods: A multi-center case-control observational study was conducted. A total of 53 PD cases and 53 age and sex matched healthy controls were included. Both descriptive and Chi-square proportional statistical analysis were used.

RESULTS: The mean age distribution was comparable between the two study groups (61.9 vs. 59.9 years). Distribution of male gender was comparable between PD and control groups (71.7% vs. 67.9%). Nearly all the individuals diagnosed with PD were on levodopa treatment, and close to half of them were on anticholinergic drugs. Hypertension was the commonest comorbid disorder in both groups. The prevalence of orthostatic hypotension was higher in PD patients (22.6%) compared to the control group (9.4%). The proportion of constipation (p=0.007), urinary urgency (p=0.007), and nocturia (p<0.0001) was significantly higher among Parkinson’s disease patients compared to the healthy control group. Falls and excessive sweating were only reported by PD patients.

CONCLUSION: The present study shows the frequency of orthostatic hypotension in Ethiopian Parkinson’s disease patients is comparable to other regions. The presence of constipation, urinary urgency, and nocturia was associated with Parkinson’s disease compared to the control group.

Renal Function Abnormalities among Patients with Acute Stroke at a Tertiary Hospital in Ethiopia

Lissane Seifu — 2022-11-01

BACKGROUND: Stroke is the leading cause of neurological disability and the second commonest cause of death globally. Despite the fact that renal dysfunction is a common comorbidity of stroke, there is no data on the prevalence of renal dysfunction among patients with acute stroke in Ethiopia. The aim of this study was to determine the magnitude of renal dysfunction, factors associated with renal dysfunction and risk of in-hospital mortality.

METHODS: A hospital-based cross-sectional study was conducted in Yekatit 12 Hospital Medical College among consecutive 192 patients, who were admitted with acute stroke from September 2020 to September 2021. Data were collected using a structured questionnaire after pilot survey was done. A Multivariate binary logistic regression analysis was fitted to identify determinants of renal function abnormalities. Renal dysfunction was defined as serum creatinine >1.2mg/dl.

RESULT: The mean age (SD) of study participants was 62.2 (15.9) years. Hundred-one (52.6%) participants were males. Thirty-four (17.7%) of the participants had renal dysfunction. Among patients with renal dysfunction, more than half of them were ≥70 years old and two-thirds were males. Male gender and hypertension increased the risk of renal dysfunction among hospitalized stroke patients. The mortality rate was higher in stroke patients with renal dysfunction (35.3%) as compared with patients having normal renal function (15.2%), but it was not a statistically significant.

CONCLUSION: Renal dysfunction was a frequent comorbidity among acute stroke patients who were hospitalized. Male gender and hypertension were statistically significant predictors of renal dysfunction. Mortality rate was higher in stroke patients with renal dysfunction, but not a statistically significant predictor of post stroke in-hospital mortality.

Assessment of Serum Uric Acid, Urea, and Glucose Levels and Associated Factors among Breast Cancer Patients Attending A Tertiary Hospital in Bahirdar, Ethiopia: A Comparative Cross-Sectional Study

Tinfash Kebede — 2022-11-01

BACKGROUND: Breast cancer is currently become a major public health problem in both developed and developing regions, it is one of the most common surgical problems in Ethiopia. Therefore, this study assessed serum uric acid, urea, and glucose levels and associated factors among benign, malignant breast cancer patients and apparently healthy women attending at Felege-Hiwot comprehensive Specialized Hospital.

METHODS: Hospital based comparative cross-sectional study was conducted among benign, malignant breast cancer patients and apparently healthy women attending at Felege-Hiwot Comprehensive Specialized Hospital. Out of 178 study participants 66 benign and 23 malignant fine needle aspirate cytology confirmed breast cancer patients and 89 apparently healthy women, included. Multivariable logistic regression models used to measure the strength of associations. A P value of < 0.05 was considered statistically significant.

RESULTS: Majority of the study participants, 81(91%) controls, 55(83.3%) benign, and 17(73.9%) malignant cases were premenopausal. Serum glucose 144.47±74.35 and uric acid 6.84±2.54 levels were significantly elevated in malignant cases than control (p-value< 0.05). Patients with malignant status were 4.38 times more likely to have hyperglycemia (AOR=4.38, 95%CI: 1.98-19.97) and 5.53 times more likely have hyperuricemia (AOR=20.43-95% CI: 6.80- 61.23), 4 times more likely to have uremia (AOR=4.09, 95% CI: 1.06-15.91) compared to apparently healthy women.

CONCLUSION: Serum glucose, and uric acid levels were significantly higher in malignant and benign cases compared with apparently healthy women. Family history of breast cancer, body mass index, systolic hypertension, comorbidity, residence and menopausal status were significantly associated with hyperglycemia, uremia and hyperuricemia.

The Effect of Preoperative Oral Melatonin on Postoperative Pain after Lumbar Disc Surgery: A Double-Blinded Randomized Clinical Trial

Afshin Gholipour Baradari — 2022-11-01

BACKGROUND: Despite advances in surgical and anesthesiology techniques, many patients continue to experience postoperative pain after lumbar disc surgeries. The aim of this study was to investigate the effect of preoperative oral melatonin on the severity of postoperative pain after lumbar laminectomy/discectomy.

METHODS: In this double blinded randomized controlled clinical trial 80 patients undergoing an elective mini-open microdiscectomy surgery at Imam Khomeini educational hospital in Sari, Iran, were selected and randomly assigned into one of four groups. Patients in group A, B, C, and D received 3, 5 and 10 mg melatonin or placebo tablets one hour before surgery, respectively. Using the visual analogue scale (VAS) the severity of pain, nausea and vomiting, pruritus, and use of narcotics were assessed immediately after surgery and before leaving the post-anesthesia care unit, 6, 12 and 24 hours postoperatively.

RESULTS: In all three groups receiving melatonin at all three different doses, postoperative pain was significantly less than the placebo group (P<0.01). There were no statistically significant differences in postoperative pain level between the three groups receiving melatonin (P>0.05). The amount of opioid received by the patients within 24 hours after surgery had statistically significant differences within the groups (P=0.043, F=2.58). The results of post hoc analysis in terms of postoperative pain intensity showed statistically significant differences between the two groups receiving melatonin at a dose of 5 mg and the placebo group (P= 0.04). No serious side effects reported in four groups.

CONCLUSION: The use of oral melatonin with a dose of 5 mg, 1 hour before the surgery as an inexpensive method can effectively reduce pain intensity as well as the amount opioid use after lumbar laminectomy and discectomy.

Screening of Extended Family Members of Thalassemia Major Children as a Thalassemia Preventive Strategy

Naresh Dattatraya Sonkawade — 2022-11-01

BACKGROUND: Thalassemia is considered as the most common single gene disorder worldwide. Preventive measures include identification of thalassemia carriers (traits) through screening, genetic counselling and prenatal diagnosis to reduce the incidence. This study aims at estimating the prevalence of carrier status detection among the extended family members of children having thalassemia major so as to use it as a screening prevention strategy with appropriate counselling.

METHODS: This cross-sectional study was conducted in thalassemia unit of Pediatric Department of a tertiary care teaching hospital over a period of 18 months. Blood samples were collected from 117 extended family members (EFM) of 23 children with thalassemia major to carry out investigations such as Complete Blood Counts (CBC), Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT), Reticulocyte count, High Performance Liquid Chromatography(HPLC) and serum ferritin. Reports were analysed to find out the prevalence of carriers.

RESULTS: Among 117 EFM, 62 (52.9%) were males while 55(47.1%) were females. Mean age distribution in this study was 16.49 years (8.5). Prevalence of thalassemia trait (carrier) was 35%. NESTROFT test was positive in 57(48.7%) participants. The binary logistic regression found only positive NESTROFT test as a predictor (adjusted OR=0.022, P=0.001) of having raised HbA2 (HbA2≥3.5 %).

CONCLUSION: Screening of thalassemia carrier by targeting extended family members of thalassemia major children could yield more carrier cases and targeted counselling could help effectively in decreasing the number of children born with thalassemia major. This strategy could be included in future plan of national prevention programme for thalassemia.

Clinical Competence and Perception of Medical Students after Early Clinical Exposure through Pre-clerckship Education at an Ethiopian Medical School: A Cross-sectional Study

Esubalew Taddese Mindaye — 2022-11-01

BACKGROUND: Conventional medical curriculum is the mainstay in the long history of modern medical education. Innovative integrated medical curriculum attracted significant attention in improving conventional curriculum. In the integrated curriculum, basic sciences are incorporated horizontally with each other, and students are exposed early to clinical settings. This is expected to improve students’ knowledge and skills in clinical medicine by the time they start their clerkship rotation.

METHOD: the study aims to make a baseline assessment on the overall knowledge and skills of medical students towards clinical medicine. An institution-based cross-sectional study was conducted from March to April of 2020 using 91 third year medical students (convenience sampling). A three-section self-administered survey instrument, short written MCQ exam, and practical (OSCE) students’ examination were used for this survey.

RESULT: participants tend to exhibit better knowledge on basics of history taking and physical examination with an average score of 79%. Comparatively, the score for average physical examination skill was low (56.3%). Students’ perception on ECE showed, over 50% of participants believe ECE increases burden on their overall workload. Even then, the majority (92.3%) still think that ECE has positive impact on their clerkship education. Taken together, it appears more hands-on interventions is needed to further improve skills of medical students in physical examination with particular emphasis on the clinical examination of breast, thyroid, musculoskeletal, and neurologic systems.

Extended-Spectrum Beta-Lactamase and Carbapenem-Resistant Gram-Negative Pathogens in Makkah, Saudi Arabia

Ahmed Kabrah — 2022-11-01

BACKGROUND: This study aimed to determine the prevalence of extended-spectrum-beta-lactamase (ESBL) and carbapenem-resistant gram-negative bacteria (GNB) isolated from patients at the King Faisal Hospital in Makkah, Saudi Arabia.

METHODS: In this cross-sectional study, a total of 298 patients admitted to the intensive care unit for 48 hours and who had a central venous catheter were selected using a census sampling method. Only patients with ESBL and carbapenem-resistant GNB-isolated organisms (175 patients) were included. The susceptibility test of GNB was carried out according to the standard recommendations. The identified strains were tested in-vitro against several antimicrobial drugs. Statistical analysis was performed using SPSS version 24.

RESULTS: 36(20.6%) of samples were ESBL-producing GNB, whereas 139(79.4%) were carbapenem-resistant GNB. The pooled proportional estimates of ESBL-producing GNB Escherichia coli, Klebsiella pneumoniae, and other GNB were 44.4%, 41.6%, and 14.0%, respectively; the pooled proportional estimates of carbapenem resistance GNB Klebsiella pneumoniae, Acinetobacter baumannii complex/hemolyticus and other GNB were 82.8%, 10.8%, and 6.4%, respectively. All ESBL-producing GNB and carbapenem-resistance GNB were multidrug-resistant pathogens. The highest carbapenem resistance GNB 139(100%) was to ampicillin, and the lowest 122(87.7%) was to Amoxicillin/clavulanic acid (Amox/clav). All ESBL-producing GNB 36 (100%) were resistant to cefotaxime, and 35 (97.2%) were resistant to ampicillin, cefuroxime, cefepime, and ceftazidime. Additionally, the effective antibiotic against ESBL-producing GNB was imipenem.

CONCLUSION: Antibiotic utilization measures appear to contribute to the control of the emergence of multidrug-resistant pathogens such as ESBL and carbapenem-resistant GNB. Strict adherence to well-accepted infection control guidelines along with caution in using broad-spectrum antimicrobial agents represents the best strategy for preventing the emergence and spread of multidrug-resistant pathogens.

The Antioxidant Activities of Ethanolic, Methanolic, Ethyl Acetate, and Aqueous Extracts of the Endemic Species, Lavandula mairei Humbert (A Comparative Study between Cold and Hot Extraction)

Ridwane Ghanimi — 2022-11-01

BACKGROUND: Medicinal plants have been used for therapeutic purposes and have shown important biological properties. This study aimed to evaluate for the first time the antioxidant activities, total flavonoid, and total phenolic contents of Lavandula mairei Humbert. The ethanol, methanol, ethyl-acetate, and water extracts were used for this purpose.

METHODS: The antioxidant activities were assessed in vitro by free radical scavenging activity against 2,2-diphenyl-1-picrylhydrzyl (DPPH), ferric reducing antioxidant power (FRAP), and total antioxidant capacity (TAC). The total flavonoid and phenolic contents were determined spectrophotometrically with gallic acid and Quercetin as standards.

RESULTS: In either Soxhlet or maceration methods, the flavonoids and the total phenolic contents were significantly higher in the methanolic extract (P<0.05) compared to other extracts. The total flavonoid content of L. mairei ranged between 119 and 224.6 mg QE/g DW for Soxhlet extracts and from 111.8 to 148.51 mg QE/g DW for maceration extracts. While the total phenolic content was between 35.12 and 99.37 mg GAE/g DW for Soxhlet extracts and 27.63 to 58.99 mg GAE/g DW for maceration extracts. In either the Soxhlet or maceration method, the highest total antioxidant capacity (TAC) was obtained using the ethanolic extract, while the aqueous extract had the highest antioxidant activity for DPPH and FRAP assays.

CONCLUSION: These results showed that Lavandula mairei Humbert has great potential to be a promising candidate for natural plant sources of antioxidants.

A Quantitative Study on the Ethnobotanical Knowledge about Wild Edible Plants among the Population of Messiwa

Ridwane Ghanimi — 2022-11-01

BACKGROUND: The preservation of traditional knowledge of wild edible plants (WEPs) is one of the challenges to the sustainability of natural resources. Therefore, it is crucial to assess the traditional knowledge of WEPs in relation to some socio-demographic and economic factors.

METHODS: The survey was conducted among the Messiwapopulationthrough a semi-structured questionnaire. The first part of the questionnaire concerns socio-demographic and economic information, while the second part concerns the plants recognized and used by the informant. The recognition frequency (RF), the use frequency (UF), the general consumption frequency(CF), the recent consumption frequency (RCF), and the correlation between these frequencies were evaluated. A comparison of means was also used to compare informant’s knowledge according to their socio-demographic and economic status.

RESULTS: The three species;Foeniculum vulgare, Ziziphus lotus, and Malva sylvestris were the most recognized (FR = 1) and the most used (FU = 1). The consumption frequency (CF) and the recent consumption frequency (RCF) for Foeniculum vulgare were 1 and 0.9, respectively. Taraxacum getulum, Calendula arvensis and Cyperus rotundus were the least recognized (FR= 0.16; 0.16; 0.48) and least used (FU = 0.3; 0.3; 0.4) species, respectively. The informants who showed a high level of traditional knowledge on WEPs were housewives, with a low level of schooling and at least 45 years old.

CONCLUSION: Despite the decline in traditional knowledge about wild edible plants, some populations preserve this knowledge, especially among the elderly. Therefore, documentation of this knowledge is necessary through ethnobotanical and ethnomedicinal studies.

Burnout among Emergency Nurses during COVID-19 Pandemic at Hail Governmental Hospitals in the Kingdom of Saudi Arabia

Bahia Galal A. Hassan Siam — 2022-11-01

BACKGROUND: Nurses’ burnout is an extended response to stressors at work, which leads to a negative self-concept and reduces the professional outcome. This study aimed to evaluate the level of burnout among emergency nurses during the COVID-19 pandemic.

METHODS: This cross-sectional study was conducted from October 2021 to December 2021. A total of 77 emergency nurses from King Khalid hospital 42 (54.5%), and King Salman Specialist hospital 35 (45.5%) in Hail city of Saudi Arabia, were selected using a convenient sampling method and included in the study. A self-administered questionnaire consisted of the socio-demographics data sheet, and the Copenhagen Burnout Inventory (CBI) tool to evaluate nurses’ burnout.

RESULTS: The overall rate of burnout among the studied nurses was moderate, with mean scores of 39±10. The highest rate was for personal burnout with mean scores of 41.4±16.5, while the lowest score was for client-related burnout with mean scores of 37.8±10.5. The total burnout mean scores for all dimensions of CBI are higher in divorced (46.7), older age (44.5), nursing technicians (43.4), low years of experience (42.5), lower educational level (41.9), non-Saudi (41.0), and males (40.5).

CONCLUSION: The prevalence of burnout among nurses in government hospitals in Hail city was moderate, which should be considered. No statistically significant association were found between socio-demographic variables and the mean scores of CBI. Therefore, it is necessary to investigate the factors associated with the occurrence of burnout, provide a training program to reduce it, and improve the mental and physical health of the emergency nurses.

COVID-19 Vaccine Side Effects among Early-Vaccinated Healthcare Workers: Correspondence

Won Sriwijitalai — 2022-11-01

Letter to the Editor

LIST OF REVIEWERS

Abraham Haileamlak — 2022-11-01

List of reviewers for 2022 issues