RESUMO
BACKGROUND: WHO does not recommend community-level health workers (CLHWs) using integrated community case management (iCCM) to treat 7-59 days old infants with fast breathing with oral amoxicillin, whereas World Health Organization (WHO) integrated management of childhood illness (IMCI) recommends it. We want to collect evidence to help harmonization of both protocols. METHODS: A cluster, randomized, open-label trial will be conducted in Africa and Asia (Ethiopia, Malawi, Bangladesh and India) using a common protocol with the same study design, inclusion criteria, intervention, comparison, and outcomes to contribute to the overall sample size. This trial will also identify hypoxaemia in young infants with fast breathing. CLHWs will assess infants for fast breathing, which will be confirmed by a study supervisor. Enrolled infants in the intervention clusters will be treated with oral amoxicillin, whereas in the control clusters they will be managed as per existing iCCM protocol. An independent outcome assessor will assess all enrolled infants on days 6 and 14 of enrolment for the study outcomes in both intervention and control clusters. Primary outcome will be clinical treatment failure by day 6. This trial will obtain approval from the WHO and site institutional ethics committees. CONCLUSIONS: If the research shows that CLHWs can effectively and safely treat fast breathing pneumonia in 7-59 days old young infants, it will increase access to pneumonia treatment substantially for infants living in communities with poor access to health facilities. Additionally, this evidence will contribute towards the review of the current iCCM protocol and its harmonization with IMCI protocol. TRIAL REGISTRATION: The trial is registered at AZNCTR International Trial Registry as ACTRN12617000857303.
RESUMO
BACKGROUND: Iodine deficiency is one of a major nutritional problem. The study aimed to assess the iodine status of populations in Dabat district using median urinary iodine concentration (UIC) in school-age children (6-12 years) and compared the results with goiter prevalence. METHODS: The study used a cross-sectional study design. The study was conducted in Dabat district, northwest Ethiopia in May 2016. Spot urine samples were used for the determination of UIC. Manual examination of the thyroid gland was performed to assess presence of goiter. The MBI international Rapid Test Kits (RTK) were used to determine the level of salt iodine content. Children aged 6-12 years were recruited from schools using a multistage stratified sampling. One-way Analysis of Variance (ANOVA) was used to compare mean of log-transformed UIC values among key variables. Significant was determined at P-value less than 0.05. RESULTS: A total of 358 school age children enrolled to the study. The mean age of children was 10.8((Standard Deviation (SD) = 1.45) years and 56.7% were males. The median UIC was 235 µg/l ((Inter Quartile Range (IQR): 161, 320]. Excessive iodine intake and inadequate iodine intake was observed on 29.1 and 8.7% of school aged children, respectfully. The coverage of iodized salt use in school-age children were 66.8%. The UIC was higher in urban children than rural counterparts and in those used adequately iodised salt than inadequately iodized salt (P < 0.05). Thirty-four percent of school-age children had a goiter. The prevalence of grade 1 and grade 2 goiter was 26.5 and 7.5%, respectively. There was a poor agreement between UIC and goiter (k = 0.1) in classifying iodine status of populations. CONCLUSIONS: The study population is classified as above requirements by median UIC in school-age children but severe iodine deficiency by goiter prevalence. Further research investigating the agreement between UIC and goiter prevalence in classifying iodine status of populations with various iodine status is warranted.
