Do deaths from road traffic injuries follow a classical trimodal pattern in North West Ethiopia? A hospital-based prospective cohort study

ObjectiveThe objective of this study was to identify timing distribution and predictors of deaths following road traffic injuries among all age groups at Gondar Comprehensive specialised hospital.DesignA single-centre prospective cohort study.SettingThe study hospital is a tertiary hospital in North West Ethiopia.ParticipantsWe enrolled 454 participants who sustained road traffic injuries in to the current study. All age groups and injury severity were included except those who arrived dead, had no attendant and when the injury time was unknown.Primary and secondary outcome measuresThe primary outcome was time to death measured in hours from injury time up to the 30th day of the injuries. Secondary outcomes were prehospital first aid, length of hospital stay and hospital arrival time. The article has been registered, with a unique identification number of research registry 6556.ResultsA total of 454 victims were followed for 275 534 person hours. There were 80 deaths with an overall incidence of 2.90 deaths per 10 000 person hours of observation (95% CI 2.77 to 3.03). The significant predictors of time to death were being a driver (AHR=2.26; 95% CI 1.09 to 4.65, AR=14.8), accident at interurban roads ((AHR (Adjusted HAzard Ratio=1.98; 95% CI 1.02 to 3.82, AR (Attributable Risk)=21%)), time from injury to hospital arrival (AHR=0.41; 95% CI 0.16 to 0.63; AR=3%), systolic blood pressure on admission of <90 mm Hg (AHR=3.66; 95% CI 2.14 to 6.26; AR=57%), Glasgow Coma Scale of <8 (AHR=7.39; 95% CI 3.0819 to 17.74464; AR=75.7%), head injury with polytrauma (AHR=2.32 (1.12774 4.79; AR=37%) and interaction of distance from hospital with prehospital care.ConclusionThough the maturation of trauma centres in many developed countries has changed the temporal pattern of deaths following any trauma, our study demonstrated that trauma deaths follow the traditional trimodal pattern. That implies that potentially preventable causes of death continued in low-resource countries.

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Incidence and Predictors of Pre-Eclampsia Among Pregnant Women Attending Antenatal Care at Debre Markos Referral Hospital, North West Ethiopia: Prospective Cohort Study

International Journal of Women s Health ◽

10.2147/ijwh.s265643 ◽

2020 ◽

Vol Volume 12 ◽

pp. 1013-1021

Author(s):

Molla Yigzaw Birhanu ◽

Habtamu Temesgen ◽

Gebreselassie Demeke ◽

Moges Agazhe Assemie ◽

Alehegn Aderaw Alamneh ◽

...

Keyword(s):

Cohort Study ◽

Antenatal Care ◽

Pregnant Women ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Referral Hospital ◽

North West ◽

North West Ethiopia ◽

Debre Markos

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Burden, Clinical Outcomes and Predictors of Stroke in Hospital Mortality among Adult Patients Admitted to Stroke Unit of Jimma University Medical Center: Prospective Cohort Study

10.21203/rs.2.9228/v2 ◽

2019 ◽

Author(s):

Ginenus Fekadu ◽

Legese Chelkeba ◽

Ayantu Kebede

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Stroke Unit ◽

Medical Center ◽

Female Ratio ◽

Hospital Arrival ◽

Time To Death ◽

Jimma University

Abstract Background: Global burden of stroke epidemiology is changing rapidly. Over the 1990–2013 period, there was a significant increase in the absolute number of deaths and incident events of stroke. The burden of ischemic and hemorrhagic stroke varies between regions and over time in Ethiopia. The paucity of data has limited research output and consequently the response to this burden in our country. Methods: Prospective cohort study was carried at stroke unit of Jimma University Medical Center (JUMC) from March 10- July 10, 2017. The outcome of interest was mortality and time to death. Data was analyzed using SPSS version 20. Multivariable Cox regression was used to identify the predictors of in hospital mortality and time to death from hospital arrival. Predictor variables with P< 0.05 were considered statistically significant. Results: A total of 116 eligible stroke patients were followed with the mean age of 55.1+14.0 years and males comprised of 73 (62.9%) with male: female ratio of 1.70:1. Stroke accounted for 16.5 % of total medical admissions and 23.6 % of the total cases of in hospital mortality. A total of 91 (78.4%) of patients were discharged being alive making in hospital mortality of rate of 25 (21.6%). The median time of in hospital mortality after admission and length of hospital stay of the patients was 4.38 days and 9.21 days, respectively. The prominent suspected immediate cause for in hospital mortality was increased intracranial pressure 17 (68.0%) followed by respiratory failure secondary to aspiration pneumonia 11 (44.0%). Brain edema (AHR: 6.27, 95% CI: 2.50-15.76), urine incontinence (AHR: 3.48, 95% CI: 1.48-8.17), National Institute of Health Stroke Scale (NIHSS) >13 during hospital arrival (AHR: 22.58, 95% CI: 2.95-172.56) and diagnosis of stroke clinically alone (AHR: 4.96, 95% CI: 1.96-12.54) were the independent predictors of in hospital mortality. Conclusions: The mortality of stroke in this set up was similar to other low- and middle-resource countries. There should be burning need to establish and strengthen the available stroke units which are well-equipped and staffed with intensive health care teams in different hospitals across the country.

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Burden, Clinical Outcomes and Predictors of Stroke in Hospital Mortality among Adult Patients Admitted to Stroke Unit of Jimma University Medical Center: Prospective Cohort Study

10.21203/rs.2.9228/v1 ◽

2019 ◽

Author(s):

Ginenus Fekadu ◽

Legese Chelkeba ◽

Ayantu Kebede

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Stroke Unit ◽

Medical Center ◽

Hospital Arrival ◽

Time To Death ◽

The Mean ◽

Jimma University

Abstract Background: Global burden of stroke epidemiology is changing rapidly. Over the 1990–2013 period, there was a significant increase in the absolute number of deaths and incident events of stroke. The burden of ischemic and hemorrhagic stroke varies between regions and over time in Ethiopia. The paucity of data has limited research output and consequently the response to this burden. Methods: Prospective cohort study was carried at stroke unit of Jimma University Medical Center from March 10- July 10, 2017. The outcome of interest was mortality and time to death. Data was analyzed using SPSS version 20. Multivariable Cox regression was used to identify the predictors of in hospital mortality and time to death from hospital arrival. Predictors with P< 0.05 was considered statistically significant. Results: A total of 116 eligible stroke patients were followed during the study period with the mean age of the patients was 55.1+14.0 years. Stroke accounted for 16.5 % of total medical admissions and 23.6 % of the total cases of in hospital mortality. A total of 91 (78.4%) of patients were discharged being alive making in hospital mortality of rate of 25 (21.6%). The mean time of in hospital mortality after admission was 4.38+3.The prominent suspected immediate cause for in hospital mortality was increased intracranial pressure 17 (68.0%). The mean length of hospital stay was 9.21+6.82days. Brain edema (AHR: 6.27, 95% CI: 2.50-15.76), urine incontinence (AHR: 3.48, 95% CI: 1.48-8.17), National Institute of Health Stroke Scale (NIHSS) >13 during hospital arrival (AHR: 22.58, 95% CI: 2.95-172.56) and diagnosis of stroke clinically alone (AHR: 4.96, 95% CI: 1.96-12.54) were the independent predictors of in hospital mortality. Conclusions: The mortality of stroke in this set up is similar to other low- and middle-resource countries. There should be burning need to establishing and strengthening the available stroke unit which are well-equipped and staffed intensive care units in different hospitals across the country is necessary.

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Incidence and predictors of surgical site infection following cesarean section in North-west Ethiopia: a prospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05640-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Daniel Bekele Ketema ◽

Fasil Wagnew ◽

Moges Agazhe Assemie ◽

Aster Ferede ◽

Alehegn Aderaw Alamneh ◽

...

Keyword(s):

Cohort Study ◽

Caesarean Section ◽

Surgical Site Infection ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Previous History ◽

Site Infection ◽

North West ◽

North West Ethiopia ◽

History Of

Abstract Background Following delivery by caesarean section, surgical site infection is the most common infectious complication. Despite a large number of caesarean sections performed at Debre Markos Referral Hospital, there was no study documenting the incidence of surgical site infection after caesarean section. Therefore, this study aimed to estimate the incidence of surgical site infection following caesarean section at Debre-Markos Referral Hospital in Amhara region, North-west Ethiopia. Methods A prospective cohort study was conducted among 520 pregnant women who had a caesarean section between March 28, 2019 and August 31, 2019. Preoperative, intraoperative, and postoperative data were collected using a standardized questionnaire. Data was entered using EpiData™ Entry Version 4.1 software and analyzed using R Version 3.6.1 software. A descriptive analysis was conducted using tables, interquartile ranges and median. The time to development of surgical site infection was estimated using Kaplan-Meier method. The Cox regression model for bivariable and multivariable analyses was done. Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to show the strength of association. Result The mean age of the study cohort was 27.4 ± 4.8 years. The overall cumulative incidence of surgical site infection was 25.4% with an incidence of 11.7 (95% CI:9.8,13.9) per 1000 person/days. Not able to read and write (AHR = 1.30,95% CI:1.19,2.11), no antenatal care (AHR = 2.16, 95%CI:1.05,4.53), previous history of CS (AHR = 1.21, 95% CI:1.11,2.31), HIV positive (AHR = 1.39, 95% CI:1.21,2.57), emergency procedure (AHR = 1.13, 95% CI:1.11,2.43), vertical type of incision (AHR = 2.60, 95% CI:1.05,6.44), rupture of membrane (AHR = 1.50, 95% CI:1.31,1.64), multiple vaginal examination (AHR = 1.88, 95% CI: 1.71, 3.20) were significant predictors of surgical site infection in this study. Conclusion This study concluded that the incidence of surgical site infection following caesarean section was relatively high compared to previous studies. Not able to read and write, have no ante natal care, previous history of caesarean section, HIV, emergency surgery, vertical type of incision, rupture of membranes before caesarean section, and multiple vaginal examinations were significant predictors of surgical site infection in this study. Therefore, intervention programs should focus on and address the identified factors to minimize and prevent the infection rate after caesarean section.

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Burden, Clinical Outcomes and Predictors of time to in Hospital Mortality among Adult Patients Admitted to Stroke Unit of Jimma University Medical Center: Prospective Cohort Study

10.21203/rs.2.9228/v3 ◽

2019 ◽

Author(s):

Ginenus Fekadu ◽

Legese Chelkeba ◽

Ayantu Kebede

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Stroke Unit ◽

Medical Center ◽

Female Ratio ◽

Hospital Arrival ◽

Time To Death ◽

Jimma University

Abstract Background: The global burden of stroke epidemiology is changing rapidly. Over the 1990–2013 periods, there was a significant increase in the absolute number of deaths and incident events of stroke. The burden of stroke varies in Ethiopia between regions and over time. The paucity of data has limited research output and consequently the response to this burden in our country. Methods: Prospective cohort study was carried at stroke unit of Jimma University Medical Center (JUMC) from March 10- July 10, 2017. The outcome of interest was mortality and time to death. Data was analyzed using SPSS version 20. Multivariable Cox regression was used to identify the predictors of in hospital mortality and time to death from hospital arrival. Predictor variables with P< 0.05 was considered statistically significant. Results: A total of 116 eligible stroke patients were followed with the mean age of 55.1+14.0 years and males comprised of 73 (62.9%) with male: female ratio of 1.70:1. Stroke accounted for 16.5 % of total medical admissions and 23.6 % of in hospital mortality. Among the total, 91 (78.4%) patients discharged alive making in hospital mortality of rate of 25 (21.6%). The median time of in hospital mortality and length of hospital stay after admission of the patients was 4.38 days and 9.21 days, respectively. The prominent suspected immediate cause for in hospital mortality was increased intracranial pressure 17 (68.0%) followed by respiratory failure secondary to aspiration pneumonia 11 (44.0%). Brain edema (AHR: 6.27, 95% CI: 2.50-15.76), urine incontinence (AHR: 3.48, 95% CI: 1.48-8.17), National Institute of Health Stroke Scale (NIHSS) >13 during hospital arrival (AHR: 22.58, 95% CI: 2.95-172.56) and diagnosis of stroke clinically alone (AHR: 4.96, 95% CI: 1.96-12.54) were the independent predictors of time to in hospital mortality. Conclusions: The mortality rate of stroke in this set up was comparable with other low- and middle-resource countries. There should be burning need to establish and strengthen the available stroke units which are well-equipped and staffed with intensive health care teams across the country. Additionally, future work must be designed to identify the barriers to improve stroke outcomes and recovery.

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