Contribution of physical factors to handpump borehole functionality in Africa.

Handpumps are the main water supply for rural communities across sub-Saharan Africa. However, studies show that >25 % of handpumps are non-functional at any time. We present results from a systematic field study of handpump borehole functionality. The study was designed to investigate the contribution of physical factors to functionality outcomes, including; hydrogeology, borehole configuration, and handpump components. To achieve this, we deconstructed and examined 145 handpump boreholes in Ethiopia, Uganda and Malawi. Pumping tests showed that 19 % of boreholes were located in aquifers with transmissivity below the minimum required to sustain a handpump. Water levels, measured during the dry season, had a complex relationship with borehole configuration and transmissivity. The handpump cylinder was <10 m below the water table at 38 % of sites, which increases the risk of the handpump running dry during intensive use and/or in areas of low transmissivity. The water column was <20 m at 23 % of sites and screens were <10 m long at 29 % of sites and often sub-optimally positioned in the borehole. Borehole depth had no clear relationship with functionality. Using multinomial regression and four functionality categories (functional; unreliable; low yield; unreliable and low yield) as dependant variables, we found that transmissivity is a significant risk factor for the classification of handpump boreholes as low yield. The configuration of the borehole (e.g. cylinder position, screen/casing configuration and water column) is a statistically significant risk factor for the classification of handpump boreholes as unreliable. Handpump components were in poor overall condition but rising main pipes were a particular problem with 53 % of galvanised pipes corroded and 82 % of uPVC pipes damaged, with implications for handpump performance. Our study highlights the importance of; understanding aquifer properties, investing in borehole siting, construction (including supervision) and commissioning, and improving the quality of components and maintenance of handpumps.

Groundwater quality: Global threats, opportunities and realising the potential of groundwater.

Groundwater is a critical resource enabling adaptation due to land use change, population growth, environmental degradation, and climate change. It can be a driver of change and adaptation, as well as effectively mitigate impacts brought about by a range of human activities. Groundwater quality is key to assessing groundwater resources and we need to improve our understanding and coverage of groundwater quality threats if we are to use groundwater sustainably to not further burden future generations by limiting resources and/or increasing treatment or abstraction costs. Good groundwater quality is key to progress on a range of Sustainable Development Goals, but achievement of those goals most affected by groundwater contamination is often hindered by of a lack of resources to enable adaptation. A range of threats to groundwater quality exist, both natural and anthropogenic, which may constrain groundwater use. However, groundwater often provides good quality water for a range of purposes and is the most important water resource in many settings. This special issue explores some of the key groundwater quality challenges we face today as well as the opportunities good groundwater quality and treatment solutions bring to enhance safe groundwater use. Legacy anthropogenic contaminants and geogenic contaminants may be well documented in certain places, such as N America, Europe and parts of Asia. However, there is a real issue of data accessibility in some regions, even for more common contaminants. This paucity of information can restrict our understanding and ability to manage and protect groundwater sources. Compared to surface water quality, large scale assessments for groundwater quality are still scarce and often rely on inadequate data sets. Better access to existing data sets and more research is needed on many groundwater quality threats. Identification and quantification of these threats will support the wise use and protection of this subsurface resource, allow society to adequately address future challenges, and help communities realise the full potential of groundwater.

Comparative performance of rural water supplies during drought.

As rural African communities experience more frequent and extreme droughts, it is increasingly important that water supplies are climate resilient. Using a unique temporal dataset we explore rural water supply (n = 5196) performance during the 2015-16 drought in Ethiopia. Mean functionality ranged from 60% for motorised boreholes to 75% for hand-pumped boreholes. Real-time monitoring and responsive operation and maintenance led to rapid increases in functionality of hand-pumped and, to a lesser extent, motorised boreholes. Increased demand was placed on motorised boreholes in lowland areas as springs, hand-dug-wells and open sources failed. Most users travelled >1 h to access motorised boreholes but <30 min, increasing to 30-60 mins, for hand-pumped boreholes. Boreholes accessing deep (>30 m) groundwater performed best during the drought. Prioritising access to groundwater via multiple improved sources and a portfolio of technologies, such as hand-pumped and motorised boreholes, supported by responsive and proactive operation and maintenance, increases rural water supply resilience.

Improving influenza surveillance in sub-Saharan Africa.

PROBLEM: Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations. APPROACH: A project known as Strengthening Influenza Sentinel Surveillance in Africa (SISA) was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance. LOCAL SETTING: Influenza surveillance systems in the target countries were in different stages of development when SISA was launched. Senegal, for instance, had conducted virological surveillance for years, whereas Sierra Leone had no surveillance activity at all. RELEVANT CHANGES: Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organized. LESSONS LEARNT: Targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership.

Coronary artery fistulae.

Coronary artery fistulae are abnormal communications between a coronary artery and a cardiac chamber or major vessel (vena cava, pulmonary veins, pulmonary artery). They are usually diagnosed by coronary arteriography. Clinical presentations are variable depending on the type of fistula, shunt volume, site of the shunt, and presence of other cardiac conditions. In this article, we review the literature regarding etiology, incidence, clinical manifestation, image studies, and management.

Maternal rubella-specific antibody prevalence in Ethiopian infants.

In countries with a high transmission rate of rubella the optimal age for universal rubella vaccination of infants is critically dependent upon the rate of loss of maternal antibodies. Few studies have investigated the decay characteristics of such antibodies. Mother:infant pairs were recruited at the Ethio-Swedish Children's Hospital, Addis Ababa, in 1994/95. Rubella antibody levels, determined by radial haemolysis, were available for analysis from 1542 infants aged 0-12 months, with 942 repeat measures, and from 846 mothers. Decay in seropositivity was well described by a delayed exponential function. The proportion seropositive at age 6, 9, or 12 months was 6-13%, 1-4%, or 0-1%, respectively, dependent upon assay cutoff level. Only infant age and mother's antibody level were important predictors of seropositivity. Results suggest that the success of vaccination at age 9 months or above would be little affected by residual maternal antibodies.

A survey of illegal abortion in Jimma Hospital, south western Ethiopia.

A cross-sectional descriptive study of induced abortion was conducted in Jimma Hospital, South-western Ethiopia to determine socio-economic factors and associated problems during February 25-May 5, 1996. There were a total of 80 patients with a diagnosis of induced abortion were enrolled of which 50 (62.5%) cases were admitted for bleeding and infections. Thirty six (45%) of all cases were primigravidae. Students accounted for 28 (35%) of the cases. Seventy (87.5%) of the cases could read and write and only 31 (38.8%) were married. Seventy (87.5%) knew presence of family planning methods, and 40 (50%) used at least once previously. Eighteen (22.5%) gave economic problems as reason for abortion, and 76 (95%) of them used either rubber tubes or roots of plants to induce the abortion. Of the total 42 (52.5%) believed that the right of abortion concerns mainly themselves. The study showed that the problem is quite significant in the area. We recommend for a wide scale community based study concerning the problem. A well organized sex education, family planning services and family education are also suggested in order to alleviate the problem.

Etiology of pneumonia, sepsis and meningitis in infants younger than three months of age in Ethiopia.

METHODS: Within a multicenter study coordinated by WHO, an investigation of the etiologic agents of pneumonia, sepsis and meningitis was performed among infants younger than 3 months of age seen at the Ethio-Swedish Children's Hospital in Addis Ababa for a period of 2 years. Of the 816 infants enrolled 405 had clinical indications for investigation. RESULTS: There were a total of 41 isolates from blood cultures from 40 infants. The study showed that the traditionally known acute respiratory infection pathogen Streptococcus pneumoniae was most common in this extended neonatal age group, found in 10 of 41 blood isolates. Streptococcus pyogenes was a common pathogen in this setting (9 of 41 blood isolates), whereas Salmonella group B was found in 5 of 41 isolates. Streptococcus agalactiae, which is a common pathogen in developed countries, was absent. A study of the susceptibility pattern of these organisms suggests that a combination of ampicillin with an aminoglycoside is adequate for initial treatment of these serious bacterial infections, but the combination is not optimal for the treatment of Salmonella infections. Among 202 infants on whom immunofluorescent antibody studies for viruses were performed based on nasopharyngeal aspirates, respiratory syncytial virus was found in 57 (28%) infants, and Chlamydia trachomatis was isolated in 32 (15.8%) of 203 infants.

Timing of development of measles-specific immunoglobulin M and G after primary measles vaccination.

A standard method for diagnosing measles is to detect measles-specific immunoglobulin M (IgM) in the serum of infected persons. Interpreting a positive IgM result from a person with suspected measles can be difficult if the person has recently received a measles vaccine. We have previously demonstrated that measles-specific IgM may persist for at least 8 weeks after primary vaccination, but it is unknown how quickly IgM appears. This study determined the timing of the rise of measles-specific IgM and IgG after primary measles vaccination with Schwartz vaccine. Two hundred eighty 9-month-old children from Ethiopia presenting for routine measles vaccination were enrolled. Sera were collected before and either 1, 2, 3, or 4 weeks after vaccination and tested for measles-specific antibodies by an IgM capture enzyme immunoassay (EIA) and by an indirect IgG EIA. A total of 209 of the 224 children who returned for the second visit had prevaccination sera that were both IgM and IgG negative. The postvaccination IgM positivity rates for these 209 children were 2% at 1 week, 61% at 2 weeks, 79% at 3 weeks, and 60% at 4 weeks. The postvaccination IgG positivity rates were 0% at 1 week, 14% at 2 weeks, 81% at 3 weeks, and 85% at 4 weeks. We conclude that an IgM-positive result obtained by this antibody capture EIA is difficult to interpret if serum is collected between 8 days and 8 weeks after vaccination; in this situation, the diagnosis of measles should be based on an epidemiologic linkage to a confirmed case or on the detection of wild-type measles virus.

The effect of timing of sample collection on the detection of measles-specific IgM in serum and oral fluid samples after primary measles vaccination.

This study compares the timing of the rise and decline of measles-specific IgM in serum samples and in oral fluid samples. Two hundred and eighty 9-month-old infants presenting for routine measles vaccination in Addis Ababa, Ethiopia, were enrolled. Paired serum and oral fluid samples were collected before and 1, 2, 3 or 4 weeks after measles vaccination. Samples were tested by using a modified antibody-capture enzyme immunoassay. For the 321 IgM-negative pre- and post-vaccination serum samples, 317 (99 %) of their corresponding oral fluid samples were IgM-negative. Among the 130 IgM-positive serum samples, 75% of their paired oral fluid samples were IgM-positive, with the percentage rising to 87% after oral fluid samples collected > or =3.5 weeks after vaccination were excluded. Among the post-vaccination serum samples, the percent IgM-positive peaked in week 3 and declined to 79% in week 4. For post-vaccination oral fluid samples, the percent IgM-positive peaked in weeks 2 and 3, and then declined to 43% in week 4. This modified antibody-capture enzyme immunoassay appears to detect vaccine-induced measles-specific IgM in the first 3 weeks after vaccination.

Comparative detection of measles-specific IgM in oral fluid and serum from children by an antibody-capture IgM EIA.

In vaccinated populations, the diagnosis of measles often requires laboratory confirmation. Serum tested by EIAs has proven sensitive and specific for diagnosing measles. For comparison of detection of measles-specific IgM in oral fluid and serum samples by an antibody-capture EIA, 163 Ethiopian infants who presented for routine measles vaccination were studied. Paired serum and oral fluid samples were collected before and 2 weeks after vaccination; 269 paired samples were adequate for analyses. Of the 104 serum samples that were IgM-positive, 95 (91%) of the paired oral fluid samples were IgM-positive. Of the 165 serum samples that were IgM-negative, 156 (95%) of the paired oral fluid samples were IgM-negative. The Pearson partial correlation coefficient for optical density readings from postvaccination oral fluid compared with serum was 0.81. Oral fluid appears to be an acceptable alternative to serum for measuring measles-specific IgM antibodies by an antibody-capture EIA.

Sociodemographic profile of children affected by AIDS in Addis Abeba.

A survey was conducted in Addis Abeba between October 2, 1993 and December 10, 1993 to assess orphanhood due to AIDS deaths. It was possible to trace only 1,047 AIDS cases among residents of Addis Abeba. During the survey, 59% of the cases and 16% of their spouses were already dead. The total number of children born to the index cases were 2186, among which, 883 (40.4%) were below 15 years of age. Two hundred eighty (30.4%) of these children had lost either one or both parents. Other social problems include ill health in 10.5% among which 3.9% had AIDS; 14.1% were school dropouts. There were also children who faced abandonment, displacement and who lacked medical care at the time of their illness. The existing coping mechanism seems to be relying on the extended family, which is an important social support system. However, there is a need to raise community awareness and strengthen the system to enhance the effort in protecting and supporting children affected by AIDS.

PIP: A survey was conducted in Addis Abeba between October 2 and December 10, 1993, to assess the extent of orphanhood due to AIDS mortality. Only 1047 AIDS cases could be traced among residents. During the survey 59% of cases and 16% of their spouses were already dead. There were 2186 children born to the index cases, 883 who were below age 15 years. 280 of these 883 children had lost either one or both parents. 3.9% of the 10.5% who were in poor health had AIDS. 14.1% had dropped out of school. Children were also identified who faced abandonment, displacement, and a lack of medical care at the time of their illness. Reliance upon the extended family is an important coping mechanism in this setting. The authors point to the need to raise the level of community awareness and strengthen the system to enhance efforts to protect and support children affected by AIDS.

Status of expanded program on immunization in a rural town--south Ethiopia.

A community based cross-sectional survey was conducted in a randomly selected kebele of Zway town, eastern Shoa, Kilil 4, to assess the status of expanded program of immunization. A total of 309 children aged 12-23 months were entered into the study. Fifty-three per cent of the children were fully immunized, 19% were defaulters and the rest were totally not immunized. The main reason for defaulting were inconvenience of vaccination time, child sickness and lack of information about the need for repeated vaccination. The main reasons for not being immunized were lack of faith in vaccination, not knowing its availability and lack of time. Inconsistent outreach programs and weak health education were the major rectifiable causes of the low coverage and high defaulter rate. Strengthening of the health education and outreach programs and development of mechanism for follow-up and defaulter tracing are recommended.