Hepatitis B and C are silent killers not yet recognized as major public health challenges in many developing countries with huge disease burden. In Ethiopia, Hepatitis B is endemic with an average prevalence of 10.8 %, and the prevalence of Hepatitis C is 2 %. The prevalence of both infections, however, is likely to be underreported due to the lack of diagnostic facilities and appropriate surveillance systems. Ethiopia is also among the many Sub-Sahara African countries lacking a coordinated and systematic national response to chronic viral hepatitis. The objective of this study is to examine the current level of response to viral Hepatitis B & C in Ethiopia with the aim to bring identified gaps to the attention of relevant stakeholders and policy makers. This cross-sectional qualitative study was based on semi-structured in-depth interviews with 21 key informants from health facilities, health offices, pharmaceutical companies, regulatory bodies, professional association and blood bank units. Participants were selected purposively based on their role in the national hepatitis response. The investigators also reviewed available policy and strategy documents, standards of practice and surveys, and paid visits to pharmaceutical premises to check the availability of antiviral drugs. Thematic analysis was employed to make sense of the data. During the data analysis process, all the authors critically read the materials, and data was triangulated by source, interpreter view and thematic perspective to ensure accurate representation and comprehensiveness, and validation of the interviewees’ responses. Once each investigator reviewed the data independently, the team reached a common understanding of the scope and contexts of the information attained. Data were subsequently reduced to key concepts, and case stories were taken with successive revisions. The key concepts were later coded into most basic meaningful categories. The World Health Organization (WHO) global hepatitis response framework was used to organize the analysis. Ethiopia is in the process of preparing strategic plan and guidelines for viral hepatitis. However, the country still lacks the required partnerships, and resource mobilization as a national health response is limited. Community awareness on the disease transmission and its sequel is poor. Viral hepatitis screening services are not widely available except for the occasional mandatory medical checkups for work or travel purposes. Healthcare providers often take no further action after diagnosing patients with viral hepatitis due to lack of treatment guidelines and strategic frameworks for screening, diagnosis, and treatment. Besides, drugs that are effective in the treatment of viral hepatitis are not available, mainly due to regulatory challenges. Viral hepatitis and its disease burden are getting little attention in Ethiopia and many low-income countries. The levels of technical guidance and financial support from the international community are low. To date, the response to the infections in Ethiopia is patchy. Thus, the country needs to formulate policy and strategies in the areas of disease surveillance, risk group identification and screening, use of the birth dose of hepatitis B vaccine, and care and treatment. Improving availability of data on viral hepatitis, access to low-cost generic drugs and developing and dissemination of treatment guidelines are also critical. Leveraging the successful Health Extension Program for a hepatitis response, and exploring ways to learn from and integrate into the HIV/AIDS program should also be considered.

Ethiopia lies in the high-risk corridor of esophageal squamous cell carcinoma in East Africa, where individuals with this malignancy often do not report established risk factors, suggesting unidentified etiologies. Here, we report the prevalence of mucosal human papillomavirus (HPV) and of Helicobacter pylori (H. pylori) detection in endoscopy-obtained esophageal and gastroesophageal junction biopsies and in oral cell specimens taken at the time of esophageal cancer diagnosis in a case–control study in Addis Ababa, Ethiopia. DNA extraction was performed from fresh frozen tissue and oral cell pellets obtained with saline solution gargling subsequently fixed with ethanol. Mucosal HPV and H. pylori DNA was detected using highly sensitive assays that combine multiplex polymerase chain reaction and bead-based Luminex technology. The proportions of specimens testing positive were expressed as percentages, with binomial 95% confidence intervals. Agreement of results between tissue biopsy and oral cell specimens was estimated using the kappa statistic. Comparison of study participants’ characteristics by test results was done using the Pearson chi-square test. HPV DNA was detected in 1 of 62 tumor specimens (2, 95% confidence interval (CI): 0–9%), corresponding to HPV16 type. HPV DNA was detected in the oral cavity of 7 cases (11, 95% CI: 5–22%) and 4 of 56 matched healthy controls (7, 95% CI: 2–17%), with multiple HPV types detected. Detection of H. pylori DNA was 55% (95% CI: 42–68%), and 20 of 34 H. pylori-positive specimens (59, 95% CI: 41–75%) were positive for the cagA gene. Agreement of detection rates between tissue and oral cells in cases was poor for HPV and for H. pylori. The prevalence of mucosal-type HPV was very low, whereas H. pylori was more commonly detected, with a high proportion testing positive for the pro-inflammatory gene cagA. These novel findings remain to be replicated in larger studies and with the addition of serological determinations to better understand their biological significance in the context of esophageal and gastroesophageal junction cancers.

BACKGROUND: Hepatitis A is a vaccine-preventable, feco-oral infection due to poor sanitary conditions. It is predominantly acquired during early childhood and results in lasting acquired protective immunity. However, it results in severe disease which can end up in acute fulminant hepatitis and hepatic failure when acquired during adolescence and adulthood. The prevalence of acute hepatitis A is increasing among children, adolescents, and young adults from higher-income households. They acquire this infection at a later age when they are exposed for the first time to contaminated food and drinks after being brought up in a relatively clean environment. This calls for the introduction of the Hepatitis A vaccine in Ethiopia; possibly as part of the Expanded Program on Immunization (EPI).METHODS: Socio-demographic and clinical data were collected from patients who were diagnosed to have hepatitis A infection at Adera Medical Center in 2020.RESULTS: This study showed that clinical acute hepatitis A is becoming common among children, adolescents, and young adults from relatively high-income families. Among patients with acute hepatitis, 89% were from middle and high-income families.CONCLUSIONS: There is a need for the incorporation of hepatitis A vaccine in the Ethiopian EPI program.

Mesenteric cysts are rare benign intra‐abdominal tumors that are usually asymptomatic and diagnosed incidentally while being investigated for other conditions or their complications. Surgical excision remains the primary treatment option. Here we present the case of a 30‐year‐old male with progressive abdominal distension, initially misdiagnosed with liver disease and refractory ascites, leading to inappropriate diuretic therapy. Subsequent imaging revealed a giant mesenteric cyst, which was successfully managed with complete surgical excision.

Dyskinesia limited only to the axial musculature is very rare, and if it is localized to the anterior abdominal wall, it is called belly dancer’s dyskinesia. Despite reports of variable clinical characteristics, a common feature is a myriad of involuntary, repetitive, sometimes painful, and often rhythmic movements of the anterior abdominal wall, with the majority being bilateral, resembling that of a belly dancer. As the symptom is mainly localized to the abdomen, patients could visit a gastroenterology service thinking it might be associated with underlying visceral pathology. Since the first report in 1990, only a few cases of belly dancer dyskinesia have been reported over the years. We herein report the case of a 54 years old female who presented to our OPD with a recurrent painless writhing movement of the abdomen, diagnosed as belly dancer dyskinesia and successfully treated with chlordiazepoxide.

Introduction and importance: Crohn's disease (CD) is a chronic, transmural inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract. Its rare involvement of the appendix can mimic acute appendicitis, often leading to misdiagnosis and inappropriate initial management. Case presentation: We report three patients who presented with right lower quadrant abdominal pain and were initially diagnosed and surgically treated for acute appendicitis. However, all were subsequently found to have ileocecal CD. Each case involved complications such as fistula formation or persistent symptoms, ultimately requiring further surgical intervention and appropriate medical therapy with immunosuppressants and biologics. Clinical discussion: These cases highlight the diagnostic challenge posed by CD when it presents with symptoms suggestive of acute appendicitis. A history of chronic or recurrent abdominal symptoms, postoperative complications, or atypical findings should raise suspicion for underlying IBD. Timely and accurate diagnosis is crucial to prevent unnecessary surgeries and reduce morbidity. Conclusion: Misdiagnosis of Crohn's disease as appendicitis led to complications and delayed care. Crohn's disease should be considered in the differential diagnosis of patients presenting with atypical or recurrent right lower quadrant abdominal pain. Early use of fecal calprotectin and imaging can aid diagnosis and improve outcomes in patients with atypical presentations. Highlights: