Current Research Projects

“Evaluation and Cost Comparison of Cervical Cancer Screening Options in Ethiopia” – Dr. Gelila Goba

Cervical cancer is the second most common female cancer in Ethiopia and approximately 7,095 women are diagnosed annually with two-thirds of these women dying from this disease. Our research aims to identify the most effective methods of screening to detect cervical cancer based on a cost-benefit analysis.  Two hospitals, Mekelle and Temben, have been selected for this implementation with an enrollment population of 250.  The selections represent both urban and rural populations from a screening program currently underway by the Tigray Regional Health Bureau (TRHB) in corroboration with the national strategy based upon sample size, population size, and prevalence of more severe, precancerous lesions.  The results will be presented to the Tigray Regional Health Bureau and the Federal Ministry of Health of Ethiopia to enhance the effectiveness of the programs currently in place.  With this evidence, we can impact women in Ethiopia, but also other limited resource settings around the world.

“Patterns and risk factors associated with Stillbirth at a Tertiary Teaching hospital in Mekelle, Ethiopia” – Dr. Gelila Goba

The rate of stillbirth in Ethiopia is not well documented, but anecdotal evidence suggests the rate of stillbirths is high. UIC GWH and Mekelle University are studying the rate of stillbirth and associated factors for women who present to Ayder Referral Hospital in Mekelle, Tigray, with known diagnosis of stillbirth, as referred by an outside institution, newly diagnosed on arrival, or who experience stillbirth while in hospital during antepartum or intrapartum. When completed, the study will provide data regarding the magnitude of stillbirth in Tigray Region and help identify possible strategies to prevent loss of early life in Tigray as well as the rest of the country and region.

“Assessment of Patient Views of Resident Physicians Communication Skills at Mekelle University Ayder Referral Hospital in Tigray, Northern Ethiopia by using Communication Assessment Tool (CAT)” – Dr. Gelila Goba

Ethiopia’s explosion in tertiary education over the past 20 years, including in medicine, has left the country with significant quantities of providers. Effort is now required to raise the quality of service provision, including in the area of physician-patient communication. Using Gregory Makoul’s Communication Assessment Tool, which was considered for inclusion in the ACGME Toolbox in 2007 and has been used in numerous studies, we are preparing to assess the communication skills of all OB/GYN and Surgery residents at Ayder Referral Hospital. We expect to collect data from approximately 1,200 patients. A successful study demonstrating the value of the CAT in helping providers communicate more effectively could serve as a template for other Ethiopian institutions and possible adoption at regional and federal levels.

“Electronic Fetal Monitoring with and without Pattern Interpretation: A Prospective Cohort Study” – Dr. Abida Hasan

Cesarean section is one of the most common surgeries performed with the intention of optimizing maternal and fetal/neonatal outcomes. One of the major indications for cesarean delivery is “non-reassuring fetal status”(NRFS). Electronic fetal monitoring is used to evaluate and manage women while they are in labor.  A fetal heart rate tracing is recorded on paper or electronically and produces a pattern to allow physicians to visually identify fetuses that are at risk for hypoxia and/or acidemia.  This practice allows for prompt intervention via intrauterine resuscitation and expedited delivery if deemed necessary.  National and international guidelines published by the International Federation of Gynecology and Obstetrics and American College of Obstetrics and Gynecology describe how fetal heart rate patterns obtained with electronic fetal monitoring should be interpreted and managed. In order to interpret fetal heart rate patterns, the ability to visualize a pattern is necessary. In hospitals where continuous fetal heart rate monitoring is available, but paper resources are depleted and electronic screens are not available, an image of the fetal heart rate pattern cannot be produced nor interpreted. Thus, electronic fetal monitoring is used as an incomplete tool has become standard of care for laboring patients. Our aim is to assess cesarean delivery rates using electronic fetal monitoring with versus without pattern interpretation in a hospital in a low-middle income country where resources are lacking. If a decrease in cesarean delivery rate is observed and/or neonatal outcomes are improved, this study may serve as an impetus to encourage electronic fetal monitoring paper-producing companies to subsidize or donate supplies to hospitals in developing countries.

 

“Current Surgical Practices and Surgical Site Infection at Ayder Referral Hospital in Mekelle, Ethiopia” – Dr. Erin Cavanaugh

Surgical site infection continues to be a major cause of morbidity and mortality around the world with LMICs disproportionately affected with rates as high as 30-40% compared to an average rate of less than 3% in high income countries. This prospective cohort study collecting data about surgical practices, pre-and post-operative care and post-operative infection from time of admission through post-operative day 30. Inpatient observational data will be collected to determine whether current practices are in line with World Health Organization’s Surgical Unit Based Safety Programme guidelines. Potential confounding risk factors for infection will be identified, and post-operative information will be collected through inpatient follow up as well as telephone calls on post-operative day one and 30to assess for signs or symptoms of surgical site infection. The results of this study will help elucidate risk factors for surgical site infection and prioritize future interventions to decrease the rate of surgical site infection at Ayder Referral Hospital, as well as other low and middle-income hospitals. The data collected regarding surgical site infection rates will also prove beneficial in measuring outcomes of any interventions that are developed as a result of this study.