Background The management of asthma, which is one of the major causes of childhood morbidity and mortality has been affected by non-adherence to recommended treatment regimens with severe consequences. The aim of the present study was therefore to explore the perceptions of the children with asthma, their caregivers and their healthcare providers towards asthma and barriers to long term childhood asthma management in an institutional setting in Addis Ababa, Ethiopia. Methods A qualitative descriptive design was followed for the present study that used individual interviews as a data collection method. The study participants were 23 pairs of children with asthma that had treatment follow-ups in two tertiary hospitals and their caregivers and eight healthcare providers who cared for these children. The data was analyzed using thematic analysis approach. Results The study findings revealed that the children’s reported adherence to the recommended treatment regimens was low and they along with their caregivers were facing physical, emotional and social burdens related to asthma. Some of the influencing factors affecting childhood asthma management were found to be the low-level implementation of the asthma management guidelines by the healthcare providers, limited awareness about asthma and its management by the children and their caregivers, use of traditional home remedies and religious healing on a complementary and alternative basis and inadequate education received from healthcare professionals. Further identified barriers to the adherence of especially inhaled corticosteroids appear to be the low necessity beliefs towards chronic administration of treatment regimens and concerns related with difficulty of administration, fear of side effects and general negative attitude towards it, in addition to their low availability and affordability. Conclusions Low awareness of the biomedical treatment regimens and use of traditional home remedies and religious healing by the children with asthma and their caregivers, the low-level implementation of the asthma management guidelines as well as low access to medications may among other things contribute to the low adherence of the children to their recommended regimens. The findings support the need for implementation of asthma management guidelines, institution of strong asthma care and education programs that are sensitive to local and individual patients’ and caregiver perceptions and experiences including emotional distress, the need to institute chronic care approach and ways to address patients’ medication access issues.

Introduction malnutrition is a common problem in Ethiopia. Studies show malnourished children in intensive care units succumb more often to infection and death but Ethiopia has no available data to assess the prevalence of malnutrition in children admitted to pediatric Intensive Care Unit and their clinical patterns, this study was conducted to assess these variables in a tertiary hospital in Ethiopia. Methods this was a retrospective cross sectional study done on 243 children, ranging from 1 month to 15 years of age, from January 2016 to December 2018. Anthropometric interpretation was done using WHO Z score charts. The assessed outcome variables were death, length of stay in pediatric intensive care unit (PICU), days on mechanical ventilator and hospital acquired infection. Collected data was entered and analyzed using SPSS 20.0 version. Results the overall prevalence of wasting was 37.8% (n=92). Stunting was seen in 45.7% (n=111). Compared to well-nourished children, malnourished children were more likely to require mechanical ventilation (78.3% versus 66.2% OR-2, p=0.045), experience longer time on mechanical ventilation (10.3±13.2 days versus 6.1±7.9 days, p=0.012), develop hospital acquired infection (HAI) more often (30.4% versus 19.2%, p=0.045), and have a prolonged length of stay (10.7±16.4 days versus 6.1±8.4 days, p=0.005). Conclusion malnutrition in our PICU was identified to be a common cause of morbidity associated with greater need for mechanical ventilation, prolonged ventilator days, increased HAI, and longer hospital stays. Taking into consideration scarcity of resources, malnutrition imposes great burden on clinical care.

COVID-19, the novel coronavirus, has posed a major threat to low- and middle-income countries (LMICs) due to inadequate health infrastructure and human resources. Ethiopia, a low-income country with the second largest population in Africa, has coordinated a strategic response, leveraging existing infrastructure and health systems and mobilizing public health professionals and specialist expert physicians for a multifaceted, unified government approach and adaptive response. Resource limitations, particularly in critical care, have still posed challenges, but the public health and clinical interventions thus far have prevented the catastrophic toll that many predicted. As the pandemic continues, Ethiopia expects to use a triple care model integrated at all levels, consisting of COVID-19 care, isolation care for suspected cases, and essential health services, and urges intensified non-pharmaceutical interventions alongside equitable global vaccine distribution as the ultimate answers to pandemic control. This paper draws on existing data, national planning and guidelines, and expertise from health leadership to describe this response in hopes of providing an example of how future large-scale health challenges might be faced in LMICs, using Ethiopia’s successes and challenges in facing the pandemic.

Rationale: Malnutrition is recognized as one of the top contributors for childhood demise in Ethiopia. Recent data indicate that the national prevalence of stunting and wasting are 37% and 7%, respectively. Studies done in low and middle-income countries indicate that malnutrition is associated with increased mortality and morbidity. The purpose of this study was to assess the prevalence of malnutrition among patients admitted to the Pediatric Intensive Care Unit (PICU), at Tikur Anbessa Specialized Hospital (TASH), the largest public hospital in Addis Ababa, Ethiopia and describe their demographics and outcomes. Methods: This was a retrospective cross sectional study done on 243 children, ranging in age from 1 month to 15 years of age, from January 2016 to December 2018. Anthropometric interpretation was done using WHO Z score. Stunting and wasting were defined by a height for age index and a weight for height index below -2 standard deviations(SD) and severe wasting and stunting if those indexes were below -3 SD. The assessed outcome variables were death in PICU, length of stay in PICU, days on mechanical ventilator, and hospital acquired infection (HAI) defined as first appearance of infection 48 hours or more after hospitalization. Univariate and multivariate analysis were performed to assess for possible associations. The institutional review board of Addis Ababa University approved the study. Results: The total number of children included in this study was 243. The mean age was 3.9 years (SD 3.9) with the majority being male (60.9%). The overall prevalence of wasting was 38.1% (n=91) and 18.4% (n=44) had severe wasting. Stunting was seen in 44.6% (n=103) of the children at admission to the PICU. Compared to non-malnourished children, malnourished children were more likely to require mechanical ventilation (78% versus 65.6%, p=0.047), experience longer time on mechanical ventilation (10.3 + 13.2 days versus 6.1 + 7.9 days, p=0.012), develop HAI more often (34.6 % versus 19.6%, p=0.013), and have a prolonged length of stay (10+ 16.4 days versus 6.1+ 8.4 days, p=0.005). A higher mortality rate (55.6% versus 47.6%) was observed in the malnourished group compared to the nonmalnourished one but statistical significance was not achieved. Conclusion: Malnutrition in our PICU was identified to be a common comorbidity associated with greater need for mechanical ventilation, prolonged ventilator days, increased HAI, and longer hospital stays. Taking into consideration scarcity of resources, malnutrition imposes great burden on acute critical illness treatment.

The three career pathways before medical school did not appear to have a role in the choice of primary care versus other specialty practices among graduates who had entered primary care residencies. However, gender did influence this choice.