Clinical Research

Research is central to the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM), to drive improvements in clinical care through context-responsive evidence generation. Over more than a decade of collaboration, faculty and trainees from Ethiopia and Canada have co-led impactful studies examining mortality trends, injury epidemiology, and practice patterns in the Tikur Anbessa Emergency Department. These include analyses of early mortality predictors, head trauma outcomes, and knowledge and uptake of peripheral nerve blocks—all foundational to shaping local policy and training priorities. Qualitative research and implementation science has also focused on the co-development of clinical decision tools, ensuring care algorithms are evidence-based and feasible in low-resource settings.

This body of work exemplifies TAAAC-EM’s commitment to capacity-building research—led by local priorities, grounded in partnership, and designed to improve health outcomes in Ethiopia and beyond.

Past Projects

Effect of a tailored sepsis treatment protocol on patient outcomes at TASH

Project Team: Lisa M. Puchalski Ritchie, Lemlem Beza, Finot Debebe, Andualem Wubetie, Kathleen Gamble, Gerald Lebovic, Sharon E. Straus, Tigist Zewdu, Aklilu Azazh, Cheryl Hunchak, Megan Landes & Dawit Kebebe Huluka

Project Description (Abstract): Despite improvement, sepsis mortality rates remain high, with an estimated 11 million sepsis-related deaths globally in 2017 (Rudd et. al, Lancet 395:200-211, 2020). Low- and middle-income countries (LMICs) are estimated to account for 85% of global sepsis mortality; however, evidence for improved sepsis mortality in LMICs is lacking. We aimed to improve sepsis care and outcomes through development and evaluation of a sepsis treatment protocol tailored to the Tikur Anbessa Specialized Hospital Emergency Department, Ethiopia, context.

PUBLICATIONS

Puchalski Ritchie LM, Beza L, Debebe F, Wubetie A, Gamble K, Lebovic G, Straus SE, Zewdu T, Azazh A, Hunchak C, Landes M. Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis. Implementation Science. 2022 Jul 19;17(1):45.

PRESENTATIONS

Debebe F, Puchalski Ritchie LM, Beza L, Straus S, Wubetie A, Landes M, Azazh A. Developing and evaluating a sepsis treatment protocol tailored to the Tikur Anbessa Hospital emergency department, Ethiopia. African Conference on Emergency Medicine (AfCEM). Accra, Ghana. November 2022. (Poster Presentation)

Barriers to and facilitators of the development and utilization of context appropriate evidence based clinical algorithms to optimize clinical care and patient outcomes in the TASH ED

Project Team: Lisa M. Puchalski Ritchie, Finot Debebe & Aklilu Azazh

Project Description (Abstract): Evidence-based clinical algorithms (EBCA) are knowledge tools to promote evidence use by codifying evidence into action plans to facilitate appropriate care. However, their impact on process and outcomes of care varies considerably across practice settings and providers, highlighting the need for tailoring of both these knowledge tools and their implementation strategies to target end users and the setting in which EBCAs are to be employed. Leadership at the Tikur Anbessa Specialized Hospital emergency department (TASH-ED) in Addis Ababa, Ethiopia identified a need for context-appropriate EBCAs to improve evidence uptake to mitigate care gaps in this high volume, high acuity setting. We aimed to identify barriers and facilitators to utilization of EBCAs in the TASH-ED, to identify priority targets for development of EBCAs tailored for the TASH-ED context and to understand the process of care in the TASH-ED to inform implementation planning.

PUBLICATIONS

Puchalski Ritchie LM, Debebe F, Azazh A. Barriers to and facilitators of the development and utilization of context appropriate evidence based clinical algorithms to optimize clinical care and patient outcomes in the Tikur Anbessa emergency department: a multi-component qualitative study. BMC Health Services Research. 2019 Dec;19:1-9.

Mixed methods process evaluation of pilot implementation of the AFEM trauma data project protocol in Ethiopia

Project Team: Adam D. Laytin, Aklilu Azazh, Biruk Girma, Finot Debebe, Lemlem Beza, Heyria Seid, Megan Landes, Julia Wytsma, Teri A. Reynolds

Project Description (Abstract): The African Federation for Emergency Medicine Trauma Data Project (AFEM-TDP) has created a protocol for trauma data collection in resource-limited settings using a clinical chart with embedded standardized data points that facilitates a systematic approach to injured patients. We performed a process evaluation of the protocol’s implementation at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia to provide insights for adapting the protocol to our setting.

PUBLICATIONS

Laytin AD, Azazh A, Girma B, Debebe F, Beza L, Seid H, Landes M, Wytsma J, Reynolds TA. Mixed methods process evaluation of pilot implementation of the African Federation for Emergency Medicine trauma data project protocol in Ethiopia. African journal of emergency medicine. 2019 Jan 1;9:S28-31.

A survey of emergency medicine and orthopaedic physicians’ knowledge, attitude, and practice towards the use of peripheral nerve blocks

Project Team: Ayalew Zewdie, Finot Debebe, Aklilu Azazh, Margaret Salmon, Christian Salmon

Project Description (Abstract): Peripheral nerve blocks (also known as regional anaesthesia) are currently used by many anaesthesiologists and emergency physicians for perioperative and procedural pain management. This is a cross sectional descriptive study conducted to evaluate knowledge, attitudes, and current practice towards use of peripheral nerve blocks for lower extremity injuries at Black Lion Hospital, a tertiary trauma centre in Addis Ababa.

PUBLICATIONS

Zewdie A, Debebe F, Azazh A, Salmon M, Salmon C. A survey of emergency medicine and orthopaedic physicians’ knowledge, attitude, and practice towards the use of peripheral nerve blocks. African Journal of Emergency Medicine. 2017 Jun 1;7(2):79-83.

The clinical profile and acute care of patients with traumatic spinal cord injury at a tertiary care emergency centre in Addis Ababa, Ethiopia

Project Team: Finot Debebe, Assefu Woldetsadik, Adam D. Laytin, Aklilu Azazh, James Maskalyk

Project Description (Abstract): Traumatic spinal cord injuries can have catastrophic physical, psychological, and social consequences, particularly in low resource settings. Since many of these injuries result in irreversible damages, it is essential to understand risk factors for them and focus on primary prevention strategies. The objectives of this study are to describe the demographics, injury characteristics, and management of traumatic spinal cord injury victims presenting to the Adult Emergency Centre of Tikur Anbessa Specialised Hospital in Addis Ababa, the tertiary referral centre for emergency care in Ethiopia.

PUBLICATIONS

Debebe F, Woldetsadik A, Laytin AD, Azazh A, Maskalyk J. The clinical profile and acute care of patients with traumatic spinal cord injury at a tertiary care emergency centre in Addis Ababa, Ethiopia. African Journal of Emergency Medicine. 2016 Dec 1;6(4):180-4.

Epidemiology and outcomes of head injury patients in an urban Ethiopian emergency department

Project Team: Megan Landes, Raghu Venugopal, Sara Berman, Spencer Heffernan, James Maskalyk, Aklilu Azazh

Project Description (Abstract): Head injury is a leading cause of mortality in Africa. We characterise the epidemiology and outcomes of head injury at an Ethiopian emergency centre. We conducted a prospective cohort study of all head injured patients presenting to the Emergency Centre of Tikur Anbessa Specialised Hospital, Addis Ababa. Data was collected via a standardised form from the patient’s chart, radiology reports and operative reports. Patients were followed until discharge, facility transfer, death, or 7 days in hospital. Consent was obtained from the patient or substitute decision maker.

PUBLICATIONS

Landes M, Venugopal R, Berman S, Heffernan S, Maskalyk J, Azazh A. Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre. African journal of emergency medicine. 2017 Sep 1;7(3):130-4.

PRESENTATIONS

Epidemiology and outcomes of head injury patients in an urban Ethiopian emergency department. African Conference on Emergency Medicine (AfCEM). Addis Ababa, Ethiopia. November 2014. (Oral Presentation)
Landes M, Venugopal R, Berman S, Azazh A. Epidemiology and Outcomes of Head Injury at an Urban Emergency Department in Ethiopia. Canadian Association of Emergency Physicians (CAEP) Conference. Ottawa, Ontario, Canada. June 2014. (Poster Presentation)

Patterns and predictors of early mortality in the TASH ED in Addis Ababa, Ethiopia: A prospective study

Project Team: Cheryl Hunchak, Sisay Teklu, Nazanin Meshkat, Christopher Meaney & Lisa Puchalski Ritchie

Project Description (Abstract): Ethiopian emergency department (ED) patients have a considerable burden of illness and injury for which all-cause mortality rates have not previously been published. This study sought to characterize the burden of and to identify predictors for early all-cause mortality among patients presenting to the Tikur Anbessa Specialized Hospital ED (TASH-ED) in Ethiopia.

PUBLICATIONS

Hunchak C, Waji ST, Meshkat N, Meaney C, Ritchie LP. Patterns and predictors of early mortality in the Tikur Anbessa hospital emergency department in Addis Ababa, Ethiopia: a prospective study. Annals of Global Health. 2015 Mar 12;81(1):204-5.

Funding

We are very grateful for the continued financial support for TAAAC-EM from the following donors and granting agencies (in alphabetical order):

Emergency Department

Emergency Department

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