Conectar
Studies have shown promising results using bone graft as a carrier for local administration of antibiotics to reduce the risk of prosthetic joint infection (PJI). The objective of this clinical trial is to determine if tobramycin and vancomycin-impregnated bone graft is safe and effective in reducing the rate of PJI after total hip arthroplasty (THA).
This study is an international, randomised, double-blinded, placebo-controlled clinical drug trial. Patients scheduled for THA (n=1100) requiring bone grafting (excluding revisions due to an ongoing infection) are randomised in a 1:1 ratio to prophylactic treatment with tobramycin and vancomycin or placebo-impregnated bone graft.
The primary outcome is the time to reoperation due to infection or diagnosis of PJI, expressed as a relative risk difference between the two groups. A risk reduction of at least 50% is considered clinically relevant. Secondary outcomes are time to and reason for reoperation and implant revision, type of micro-organism and antibiotic susceptibility pattern within 2 and 5 years after surgery. Safety outcomes are the number of adverse events and revision rate due to aseptic loosening. The primary analysis will be performed using proportional hazard models.
The study has been approved under the Clinical Trial Regulation No 536/2014 (EU CT; 2024-510921-25-00). Results will be published in open-access peer-reviewed journals and disseminated to patient organisations and the media, and de-identified individual participant data will be curated and shared on reasonable request in accordance with the Findability, Accessibility, Interoperability and Reuse principles, subject to the laws and regulations governing data protection in each participating country.
Neglected fractures and dislocations are a common and clinically important problem in low- and middle-income countries, often attributed to limited access to timely orthopaedic care, financial barriers, referral delays and prior non-formal treatment. Despite their clinical significance, no standardised definition or classification exists. Reported time thresholds, defining criteria and classification approaches vary substantially across and even within anatomical regions, injury types and practice settings, limiting clinical communication, research comparability and burden estimation. This study aims to develop an expert consensus-based definition and classification system for neglected fractures and dislocations, focusing on identifying a common denominator applicable across various anatomical regions and injury types, using a modified Delphi methodology.
A three-round, international, online modified Delphi study will be conducted involving purposively selected experts representing diverse geographical regions, subspecialties and practice settings, with approximately 200 experts invited to achieve a final panel of 20–30 participants. Questionnaire development was informed by a concurrent scoping review of the literature. Round 1 will explore the definitional elements and scope of the term as applied in orthopaedic practice, including the relative importance of temporal, biological, clinical and treatment-related factors that are often used to describe this entity, whether neglected fractures and dislocations are best conceptualised as a binary entity or a graded clinical spectrum, and whether defining criteria should vary across anatomical regions or different injury contexts. Round 2 will refine and present unresolved concepts and evaluate anatomic-specific operationalisation, including specific time thresholds and characteristic clinical and biological features. Round 3 will seek final consensus on the proposed definition and classification, including clarity, acceptability and perceived clinical usability. Consensus will be predefined as ≥70% agreement (7–9 on a 9-point Likert scale), with strong consensus defined as ≥80%. Free-text responses will undergo directed thematic content analysis. The study will be designed, conducted and reported in accordance with the Conducting and REporting of DElphi Studies (CREDES) checklist.
Ethical approval has been obtained from the Addis Ababa University Institutional Review Board (reference: 007/26/Ortho). Findings will be disseminated through a peer-reviewed publication and presentations at scientific meetings.
https://osf.io/jx4ew/overview?view_only=5bcabab130964c90ba0d2d1f17b8f247
To explore the barriers and facilitators influencing the implementation of continuous positive airway pressure from the perspective of healthcare providers (HCPs) in primary hospitals of four regions in Ethiopia.
A qualitative descriptive study employing thematic analysis of data collected through in-depth interviews from the perspective of HCPs.
The study was conducted in twelve selected primary hospitals in four regions of Ethiopia: Oromia, Amhara, Tigray and Sidama.
28 HCPs who worked in neonatal intensive care units (NICUs) and delivery rooms, including nurses, midwives, general practitioners, coordinators and medical directors, were interviewed in person and in-depth. Additionally, to ensure a diverse range of viewpoints, participants were identified in collaboration with hospital management and interviewed until data saturation was reached.
The study explored participants’ comprehensive experiences concerning the barriers to and facilitators of the implementation of CPAP, as well as their suggestions for enhancing its adoption.
Seven all-encompassing themes emerged: (1) providers’ knowledge and experience, (2) training and mentorship, (3) communication, (4) perceptions of CPAP, (5) equipment availability and accessibility of CPAP, (6) management and infrastructure and (7) provider-driven recommendations. Significant barriers included inadequate and inconsistent training, staff rotation, limited mentorship opportunities, poor interdepartmental communication, misconceptions regarding oxygen requirements, equipment and supply shortages, unreliable power sources and inadequate managerial backing. Facilitators included improved provider familiarity with CPAP indications, structured mentorship initiatives, internal case discussions, backup power allocation to NICUs and prioritisation strategies for critically ill neonates.
CPAP implementation in primary hospitals is influenced by interconnected individual, institutional and systemic factors. Sustainable scale-up in resource-limited settings requires practical training, mentorship, staff retention, dedicated funding and infrastructure and strong institutional and external partnerships.
by Saba Desta Tessema, Mesfin Tadese, Solomon Hailemeskel, Chaltu Takele Mule, Getaneh Dejen Tiche, Lidya Asalefew Mekonnen, Getnet Mitike Kassie
BackgroundMaternal mortality in Ethiopia remains high, while most of these deaths are preventable. Early detection of deterioration and prompt response are essential to reduce these preventable deaths. The Maternal Early Warning System (MEWS) is a reliable clinical tool for this purpose. However, its effectiveness is underexplored and its bedside use is inconsistent. This study evaluated the MEWS model for predicting and reducing severe maternal outcomes.
MethodA parallel, quasi-experimental study design was conducted among 1138 obstetric inpatients at four public hospitals of North Shewa Zone, Ethiopia. The recruitment period was from 05/05/2025–31/8/2025. The intervention group (n = 569) was monitored using the MEWS chart, which included vital signs, oxygen saturation, urine output, consciousness, and pain, and for the postpartum women; vaginal bleeding, uterine contraction, and perineal tear, were categorized as Green, Yellow, or Red. The control group (n = 569) received the standard clinical monitoring. A multivariate generalized estimating equation (GEE) model with Poisson regression was used to compare the outcomes and estimate adjusted risk ratios (aRR) with 95% confidence intervals.
ResultThe mean duration from admission to the first trigger was shorter by 4.7 hours (5.61 vs. 10.27 hours), trigger to physician evaluation by 22.6 minutes (49.3 vs. 71.9 minutes), and trigger to clinical intervention by 11.3 minutes (14.6 vs. 25.9 minutes) among women in the intervention group. Women also underwent fewer ultrasound scans (1.32 vs. 2.30) and had a shorter hospital stay by about 0.5 days (4.83 vs. 5.29 days). Women monitored with the MEWS chart had a 20% lower risk of severe maternal outcomes (aRR = 0.85, 95% CI: 0.73–0.99). Additionally, MEWS-monitored women were 9% more likely to be triggered for timely clinical response (aRR = 1.15, 95% CI: 1.03–1.28).
ConclusionImplementation of the MEWS was associated with earlier detection of maternal deterioration, shorter clinical response, fewer ultrasound investigations, shorter hospital stays, and lower severe maternal outcomes. Further studies with larger number of clusters are needed to evaluate the effectiveness of MEWS across different risk groups and settings.
Trial registrationPan African Clinical Trial Registry (PACTR), PACTR202506739780428, https://pactr.samrc.ac.za
To explore transition experiences of newly graduated nurses transitioning into long-term care and home and community care.
Scoping Review.
Joanna Briggs Institute framework and Arksey & O'Malley's principles for scoping reviews were used. Covidence facilitated evidence selection. Two independent reviewers screened and extracted data, with a third resolving disputes. NVivo 14.0 supported data analysis, and thematic analysis highlighted transition experiences.
Data retrieved from Medline, EMBASE, CINAHL, PsycINFO, Scopus, Google Scholar and Google for published and grey literature; searched February 2026.
From 27 articles, analysis revealed four themes: (1) A Different World: Contextual Challenges in Long-Term Care and Home and Community Care Sectors, (2) Navigating as a New Graduate Nurse: Knowledge, Skills, and Behaviours, (3) Support and Guidance, (4) Emergence of Professional Self as a Nurse in Long-Term Care and Home and Community Care.
This review emphasized the need for addressing clinical and emotional aspects of transition, including proper orientation, tailored nurse residency programs, and workload management for facilitating integration and supporting development of nurses' professional identity.
This review may guide healthcare leaders in refining support systems for new nurses, ultimately elevating patient care standards in these sectors.
Addressing challenges new nurses face when assimilating into long-term care and home and community care environments may enhance nurse confidence, job satisfaction, recruitment, and retention.
The EQUATOR guidelines for PRISMA-ScR.
No patient or public contribution.
To assess the level of health system responsiveness (HSR) and its associated factors among outpatients attending primary healthcare units (PHCU) in Arba Minch, South Ethiopia.
Facility-based cross-sectional study.
Three PHCUs (one primary hospital and two health centres) in Arba Minch town, Southern Ethiopia.
A total of 379 outpatients aged 18 years and above were selected using a systematic random sampling.
Primary outcome: level of HSR, measured across seven domains (communication, confidentiality, basic amenities, dignity, choice, prompt attention and autonomy) using a 28-item tool adapted from the WHO HSR framework. Secondary outcome: factors associated with HSR, identified via bivariate and multivariable linear regression.
The overall HSR was 59.4%. The highest-performing domains were confidentiality (73.9%) and dignity (70.7%), while the choice of healthcare provider was rated lowest (34.6%). In multivariable linear regression analysis, factors significantly associated with HSR score were travel time to reach the health facility on foot (β = –0.26, 95% CI –0.37 to –0.14); out-of-pocket payment for transport (β = –6.51, 95% CI –8.33 to –4.70); patient satisfaction score (β=1.57, 95% CI 1.27 to 1.88) and perceived quality of healthcare score (β=0.32, 95% CI 0.14 to 0.49).
HSR among outpatients in PHCU was moderate, with several individual and service-related factors associated with patient experiences. These findings suggest the need for focused interventions to improve responsiveness domains, although more research is required to demonstrate causal relationships.
by Osman Yimer Mohammed, Kerstin Erlandsson, Tewodros Seyoum, Solomon Hailemeskel, Lemma Derseh, Helena Lindgren
BackgroundWork-related musculoskeletal disorder is a limiting, painful condition that affects the muscular, skeletal, articular, and nervous tissues of the body. The condition is mainly associated with poor working conditions and awkward body positions. Health professionals, including midwives, are among the most affected workforce globally. The condition affects the health of the professionals and the quality of care that professionals are expected to provide. However, there is a scarcity of information on the magnitude of the condition, its effect on midwifery practice, and associated factors. Objectives: This study aimed to assess the magnitude of work-related musculoskeletal disorder, its effect on midwifery practice, and associated factors among midwives in North Shoa Zone, Amhara Regional State, Ethiopia.
MethodAn institution-based cross-sectional study assessed the magnitude of work-related musculoskeletal disorder (WRMSD), the effect on midwifery practice, and associated factors. The Nordic Musculoskeletal Disorder Scale was used to assess the presence of WRMSDs in the nine regional body parts and its effect. A stepwise backward elimination logistic regression model was used, and significant association was declared at a p-value of less than 0.05.
ResultsA total of 473 (252 (53.3%) female and 221 (46.7%) male) midwives participated in this study. Overall, in the last 12 months, 355 (75.05%, 95% CI: 71.15% − 78.95%) midwives were affected by WRMSD, which was seen in any one of the nine regional body parts. About 45% (162) of them reported being unable to perform their daily tasks while they were affected, and 27% (96) of them sought treatment for their condition. The lower back was the most affected axial body part, reported by 300 (63.4%, 95% CI: 59% − 68%) midwives. Working in awkward or uncomfortable positions was significantly associated with the development of WRMSD (AOR: 1.81, 95% CI: 1.15–2.87). Similarly, awkward positions significantly affected the development of area-specific WRMSD in the lower back, upper back, neck, and limbs. Working in the same position for a longer time, seeing clients daily, and moving heavy objects were among the risk factors associated with developing area-specific WRMSD among midwives.
ConclusionThe magnitude of work-related musculoskeletal disorders is high among midwives, and a significant number of them were unable to perform their daily tasks. The lower and upper back are the most commonly affected areas. Working in uncomfortable positions and attending to large clients daily were common risk factors. Therefore, training midwives about safe working positions and reducing the workload is commendable.
by Caitlin D. October, Dzunisani P. Baloyi, Lario Viljoen, Rene Raad, Dillon T. Wademan, Megan Palmer, Juli Switala, Michaile G. Anthony, Karen Du Preez, Petra De Koker, Anneke C. Hesseling, Bronwyne Coetzee, Graeme Hoddinott
Children who are hospitalised for tuberculosis (TB) experience challenges that put them at risk of developing emotional, behavioural, and social difficulties. In this methodological paper, we showcase the development of a narrative intervention toolkit with key components of the resulting version 1.0 tool. The study design was participatory and pragmatic, with researchers working with the routine staff of TB hospital wards, children admitted and their caregivers, to iteratively understand and improve children’s experiences of hospitalisation. The project included three phases: (1) a situational analysis to map children and healthcare providers’ perspectives on priorities and potential intervention components, (2) co-development of a beta-version of the intervention, and (3) piloting and incremental refinement toward a version 1.0 of the intervention. The intervention toolkit combined a series of activities alongside the story of ‘Courageous Curly’ to facilitate children’s engagement with their own experiences of hospitalisation, including psychosocial and treatment challenges, captured, and described throughout data collection. We found that dividing the story into short chapters facilitated children’s engagement with the section of story that is being told on a specific day. Each chapter of the story follows/mimics a different stage children can expect during their treatment journey while hospitalised for TB care. Implementation and evaluation of such interventions can mitigate the psychosocial impact of TB in children and inform policies to improve their overall TB care.by Hailemariam Gezie, Endalk Birrie Wondifraw, Muluken Amare Wudu, Habtam Gelaye, Fekadeselassie Belege Getaneh
BackgroundNeural tube defects (NTDs) are severe congenital anomalies resulting from the incomplete closure of the embryonic neural tube, affecting around 300,000 newborns globally each year and leading to significant mortality and disability. While high-income countries have seen a reduction in NTD prevalence, developing nations like Ethiopia continue to face high rates. Families impacted by NTDs often endure emotional challenges, including grief, anxiety, and social isolation. This study aims to investigate the birth prevalence of NTDs and the associated parental stress, emphasizing the wider effects on families.
MethodologyAn institution-based cross-sectional study was conducted in Dessie and Deber Berhan comprehensive specialized hospitals from July 24, 2023, to July 24, 2024, to evaluate the birth prevalence of NTDs and the associated parental stress among parents of children aged 1 month to 12 years diagnosed with NTDs. A total of 308 parent-child pairs participated in the study. Data were gathered using a pretested questionnaire and an 18-item Parenting Stress Scale. Statistical analysis was performed using Stata version 17, where linear regression was utilized to identify significant predictors after verifying the necessary assumptions. The findings were presented in multiple formats for clarity and comprehensibility.
ResultsThe overall birth prevalence of neural tube defects was found to be 0.0052 (95% CI: 0.0038, 0.0067), which translates to 52 cases per 10,000 deliveries. Key factors associated with increased parental stress included being a mother (β = 2.51), older parental age (β = 0.18), the child’s age (β = 0.81), a prior history of having children with NTDs (β = 7.88), and the presence of a ventriculoperitoneal shunt in the child (β = 4.66).
ConclusionThe findings of this study indicate that the birth prevalence of NTDs is becoming a significant public health concern. Additionally, several factors contributing to increased parental stress were identified, including older parental age, the child’s age, a previous history of NTDs in siblings, and the presence of a ventriculoperitoneal shunt. These results highlight the urgent need for targeted support and resources for affected families to help mitigate the psychological impact associated with these conditions.
by Mesay Milkias, Semagn Mekonnen, Hailemariam Getachew, Hailemariam Mulugeta, Siraj Ahmed, Melkamu Kebede, Belete Destaw, Medhanit Melese, Zemedu Aweke
BackgroundPost-operative pain is among the major post-cesarean problems, with an incidence ranging from 25.5% to 80%. Despite its simplicity, the effectiveness of wound infiltration with a mixture of bupivacaine and tramadol is still unknown. Therefore, this study aims to compare the analgesic effectiveness of wound infiltration with bupivacaine versus a combination of bupivacaine and tramadol for postoperative pain management among parturients undergoing cesarean section under spinal anesthesia.
MethodologyA double-blind, parallel, randomized controlled trial was conducted on 60 parturients. Parturients were randomized to take either bupivacaine (B = 30) or a combination of bupivacaine and tramadol (BT = 30). The homogeneity of variance was assessed using Levene’s test, and normality was assessed using the Shapiro-Wilk test. A numeric rating scale was used to measure pain severity. The independent t-test and the Mann-Whitney U test were used, respectively, for parametric and non-parametric data. A generalized estimating equation was used to assess repeated measurements.
ResultIn total, 60 parturients were analyzed with no dropouts. The severity of pain at the 6th hour was six times greater in the B group compared to the BT group (OR = 6.289, CI, 2.097–18.858, P = 0.001). The mean tramadol consumption was lower in the BT group (140.00 ± 48.066 mg) than in the B group (175.00 ± 34.114 mg), with a statistically significant mean difference of 10.761 (95% CI, 13.459 to 56.541), t (58) = 3.252, P = 0.002, (d = 0.839). The mean first analgesia request time was higher in the mixture of the BT group (367.33 ± 50.099 min) than in the B group (216.33 ± 68.744 min), with a statistically significant difference of 15.530 (95% CI, −182.087 to −119.913), t (58) = 5.6553, P = 0.001.
ConclusionWound infiltration with a combination of bupivacaine and tramadol is more effective than bupivacaine alone for postoperative analgesia in pregnant patients who underwent cesarean section under spinal anesthesia. This clinical trial study was registered at the Pan African Clinical Trial Registry with a unique trial registration number of PACTR202310525672884 (13/10/2023).
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