Traditional beliefs and disease practices of Ethiopian Jews.

In an attempt to assess concepts of disease, we questioned 33 Ethiopian Jews (Falashas) in Ethiopia about 13 diseases: 8 western and 5 cultural syndromes (in the Amharic language): birrd (cold), wugat (stabbing chest pain), moygnbagegn (neurologic disorder), mitch (sunstroke), and attent hono kere (retained fetus becoming bone). Disease causation was often attributed to spirits and the sun. None of the interviewees understood the cause of: a) epilepsy, most attributing it to spirits and recommending smelling match smoke as treatment, b) prolonged labor, attributed by most to the evil kole spirit and is managed by traditional birth attendants; and c) abortion, believed to be caused by exposure to sun or cold. Less than 20% linked malaria to mosquitoes. Most correlated splenomegaly with malaria. Hepatitis was believed to be caused by a bird or bat flying around the affected person. Multiple factors were linked to diarrhea, including a journey in the sun. Moygnbagegn is the only condition treated by venisection from brachial veins; wugat is treated by "cupping". Modern medicine was recommended by < 30% of those questioned for epilepsy, splenomegaly, hepatitis, and Ethiopian cultural diseases. It was recommended most for malaria (52%), sexually transmitted diseases (55%), and diarrhea (69%).

Endocarditis in Ethiopia. Analysis of 51 cases from Addis Ababa.

Fifty-one cases of infective endocarditis in 47 Ethiopians over several years are analyzed. There were 32 males and 19 females, average age was 20.5, with 34 < or = 20. Only 2 patients had a known source of infection. Forty-four cases had underlying rheumatic heart disease, 7 had congenital heart disease of which 5 had patent ductus arteriosus. Staphylococcus aureus and S. epidermidis were the most commonly cultured organisms (10 each), only 1 streptococcus was isolated; 28/47 cultured cases had negative cultures. Eight patients (16%) died. In comparison with western studies, this group was much younger and had a higher prevalence of rheumatic heart disease. Mitral valve prolapse and degenerative valvular disease common in the West were not seen in this population. The rate of negative cultures was much higher than the 5-10% reported in the west, most likely due to previous use of antibiotics and problems with culture techniques.

Hemoptysis in rheumatic heart disease.

107 Consecutive patients with rheumatic valvular heart disease (41 males, 66 females, average age 24.2 years) being followed at an Ethiopian cardiology referral clinic were examined and questioned about their experience of hemoptysis. 51 Patients (48%) gave a history of hemoptysis; 11 described their usual hemoptysis as frank blood, 40 as blood-streaked sputum. 29 patients had frequent hemoptysis, 13 had several episodes, and 9 only 1 occurrence. Prevalence of hemoptysis did not vary significantly by sex, physical findings, New York Heart Association classification, or valvular lesion, including the presence or absence of mitral stenosis. A majority (64) had been tested for tuberculosis, with 5 having been treated for active disease. Hemoptysis is a common manifestation of rheumatic heart disease, and is usually well tolerated.

Tetanus in Ethiopia: analysis of 55 cases from Addis Ababa.

Fifty five cases of tetanus in patients over age 11 years from 6 Addis Ababa hospitals over several years are analyzed. No patient had been immunized. Mean age was 30, male:female 39:16, 34 patients were admitted from April through August (P less than .05). Most common causes of wounds were metal objects, thorns, and nails. There was no history of trauma in 8 patients. Mean incubation period was 11.9 days (range 1-90 days), mean invasion period was 38 hours (range less than 1 day-9 days). All cases were generalized tetanus, clinically diagnosed. Laboratory data was not helpful in management. Patients were treated with tetanus antitoxin, antibiotics, and sedatives. 15 patients (27%) died, there was no correlation between treatment and outcome. Deaths correlated with short incubation and invasion periods, and presence of abdominal rigidity, tachycardia, sweating, and fluctuating blood pressure. Only 3 patients received tetanus toxoid prior to discharge. Comparison is made with African and western studies. Tetanus remains a significant problem in Ethiopia, and vaccination is highly recommended.

Takayasu's disease in an Ethiopian.

A 26-year-old Ethiopian woman with past history of stroke, presented with complaints of weakness, dyspnea on exertion, headache, and orthopnea. She had severe hypertension, asynchronous pulses, radial-femoral lag, cardiomegaly, and left ventricular hypertrophy. Blood studies were normal. Arteriogram in America showed aortic and mitral incompetence, bilateral subclavian occlusion distal to the origin of the vertebral arteries, with occluded hepatic and superior mesenteric arteries. The infrarenal abdominal aorta and common and external iliac arteries were occluded bilaterally. Renal arteries were normal. Takayasu's arteritis, inactive, was diagnosed. She underwent bilateral carotid-subclavian bypass, thromboendarterectomy of the abdominal aorta, and aorto-iliac bypass grafts. 3 years later she is greatly improved. This is the first report of Takayasu's arteritis from Ethiopia. International studies on the disease are summarized.

The pattern of tuberculosis in Addis Ababa, Ethiopia.

Two hundred and forty available charts of medical patients treated for tuberculosis at Tikur Anbessa Hospital in Addis Ababa, Ethiopia over 2 years (9/83-9/85 were studied. TB was diagnosed in 11.2% of medical admissions. The average age of TB patients was 30.5; 58% were males; 53% were classed as poor. TB patients were poorer than other medical patients and averaged 38.9 days in hospital, non-TB patients averaged 31.9 days. Pulmonary disease was most common (47% of total), followed by spondylitis (12.1%), peritonitis (11.5%), and disseminated disease (11.1%). There were no cases of renal or cutaneous disease. 6% of admissions were diabetic, 16.4% had defaulted from previous TB treatment. Only 45% of patients had the diagnosis proven by histology or bacteriology. Pleural biopsy, lymph node biopsy, peritoneal biopsy, and sputum AFB stain were the most useful procedures in proving the diagnosis. A variety of drugs were given, 53% received INH-EMB-SM, 26% INH-SM-Thiacetazone; 32% received no form of vitamin supplements. The overall death rate was 8%, including 9% of pulmonary cases and 22% of patients with disseminated disease. Comparison is made with Ethiopian and other African data. It is suggested that patients receive definitive diagnostic tests earlier, along with earlier therapy and more consistent use of pyridoxine.

Recurrence of rheumatic fever after valve replacement.

While recurrence of rheumatic fever is common, recurrence after valve replacement has not been reported. A 15-year-old Ethiopian boy returned from America after mitral valve replacement in May 1986. He did not take antibiotic prophylaxis and, in February 1987, had recurrent rheumatic fever. The literature on recurrence of rheumatic fever and prophylaxis is reviewed. Monthly injections of benzathine penicillin have been shown to be the most effective drug to prevent rheumatic fever recurrences. It is recommended that patients with rheumatic heart disease in the developing world should take prophylaxis for life.

Health and medical care in Ethiopia.

PIP: Ethiopia is a country of 45 million people in northeast Africa. With a stagnant, agriculture-based economy and a per capita gross national product of $110 in 1984, it is one of the world's poorest nations. 70% of the children are mildly to severely malnourished, and 25.7% of children born alive die before the age of 5. Life expectancy is 41 years. The population is growing at the rate of 2.9%/year, but only 2% of the people use birth control. After the 1974 revolution, the socialist government nationalized land and created 20,000 peasant associations and kebeles (urban dwellers' associations), which are the units of local government. The government has set ambitious goals for development in all sectors, including health, but famine, near famine, forced resettlement programs, and civil war have prevented any real progress from being made. The government's approach to health care is based on an emphasis on primary health care and expansion of rural health services, but the Ministry of Health is allocated only 3.5% of the national budget. Ethiopia has 3 medical schools -- at Addis Ababa, Gondar, and the Jimma Institute of Health Sciences. Physicians are government employees but also engage in private practice. A major problem is that a large proportion of medical graduates emigrate. Ethiopia has 87 hospitals with 11,296 beds, which comes to 1 bed per 3734 people. There are 1949 health stations and 141 health centers, but many have no physician, and attrition among health workers is high due to lack of ministerial support. Health care is often dispensed legally or illegally by pharmacists. Overall, there is 1 physician for 57,876 people, but in the southwest and west central Ethiopia 1 physician serves between 200,000 and 300,000 people. In rural areas, where 90% of the population lives, 85% live at least 3 days by foot from a rural health unit. Immunization of 1-year olds against tuberculosis, diphtheria-pertussis-tetanus, poliomyelitis, and measles is 11, 6, 6, and 12% respectively. Infectious diseases dominate the medical scene in Ethiopia. In 1984, tuberculosis accounted for 11.2% of hospital admissions and 12.2% of deaths. The leading cause of childhood mortality in 1984 was diarrhea (45%). Malaria, trypanosomiasis, schistosomiasis, leishmaniasis, and meningococcal meningitis are endemic. Intestinal parasitism is rampant, and the nationwide prevalence of leprosy is 3/1000. Venereal diseases were the 9th most common cause of hospital outpatient visits in 1984, but AIDS is rare. The leading noninfectious diseases are rheumatic and syphilitic heart disease, hypertension, diabetes mellitus, hepatoma, and elephantiasis. Ethiopia has the highest number of cases of nonfilarial elephantiasis -- an estimated 350,000 cases -- in the world. Aside from a large influx of money, the most necessary changes to improve the health system are lowering the salaries of doctors and nurses, reorienting physician training toward primary health care, increasing the quality of existing health services, more efficient management, and better coordination between the Ministry of Health and the voluntary organizations.^ieng

Tetanus in leprosy patients: report of five cases.

It has long been noted that tetanus is rare in leprosy patients. Five cases of tetanus are reported in leprosy patients in Addis Ababa, Ethiopia. Although natural immunity to tetanus occurs and this appears to be higher in leprosy patients than in the general population, it is not completely protective. Further research on the relationship between tetanus and leprosy is indicated. Although firm epidemiologic data are lacking, it is prudent to give leprosy patients at least one dose of tetanus toxoid.

Pattern of heart disease in Ethiopia as seen in a cardiology referral clinic.

385 patients were seen in the cardiology clinic of Tikur Anbessa Hospital, Addis Ababa, Ethiopia over 20 months. Of 338 with defined pathology, 152 had rheumatic heart disease, 47 were hypertensive, 39 had cardiomyopathy, 36 had congenital heart disease and 24 arrhythmia. Average age of rheumatics was 25.5, 78% were less than or equal to 30, male:female = 58:94. The mitral valve was affected in 91%; 18% of rheumatics had pure mitral stenosis and 56% only mitral involvement. Average age of cardiomyopathy patients was 52, 90% had dilated cardiomyopathy. In congenital cases, mitral valve prolapse was most common (25%), followed by ventricular septal defect (19%), and patent ductus arteriosus (19%). Comparison is made with Ethiopian and other African data. Clearly, rheumatic fever is the main cause of cardiac pathology in Ethiopia, and deserves greatly increased attention.