Clinical profile and risk factors for perforation of acute appendicitis in children.

OBJECTIVES: To describe the clinical profile and determine the risk factors associated with perforation of appendix in children under 13 years of age. DESIGN: A retrospective review of charts of children admitted for appendicitis between the year 1999 to 2000. SETTING: Department of Paediatrics and Child Health, Tikur Anbessa Specialised Hospital, Addis Ababa University, Addis Ababa, Ethiopia. SUBJECTS: A total of 147 children under the age of 13 years admitted for acute appendicitis. RESULTS: A total of 147 cases were analysed. The mean age was 9.3 years and appendicitis occurred more commonly among males. Factors independently found to be predictors of perforation by univariate analysis were: age <10 years, duration of illness for over 24 hours, history of treatment elsewhere before arrival to TAH, generalised abdominal tenderness, rebound tenderness and/or rigidity, hypoactive and/or absent bowel sound, RLQ mass, leukocytosis with neutrophilia and presence of complications. However, none of these was retained as significant factors in the multiple logistic regression analysis. CONCLUSION: There are many factors that are associated with perforation but there is no single factor that independently predicted perforation of appendicitis. Delay in intervention due to late presentation to hospital is an important preventable factor.

Determinants of diarrhoeal diseases: a community based study in urban south western Ethiopia.

OBJECTIVES: To identify the determinants and describe the extent of diarrhoeal diseases among under-five children in urban Ethiopia. DESIGN: Community based, cross-sectional study. SETTING: Jimma, a town in south western Ethiopia, is an urban area with multi-ethnic population. The town is divided into 20 kebelles. Each kebelle has a population of about 5000 people. SUBJECTS: Six hundred and five children under the age of five years were selected by random sampling. There were 142 children with diarrhoeal diseases in selected households. All those without diarrhoea were taken as controls. RESULTS: The incidence at diarrhoeal diseases was 5.48 episodes per child per year. The incidence of persistent diarrhoea was 7.75%. About 24.5% of the acute diarrhoeal diseases (ADD) culminated to persistent diarrhoea. Well source of water, lack of complete immunization, attack of measles and acute respiratory infecions (ARI) in the previous two weeks were found to be significantly associated with occurrence of diarrhoeal disease; however, only ARI and well water were retained in the logistic regression analysis. CONCLUSION: The incidence of diarrhoeal diseases and the progression to persistent diarrhoea are very high. Many of the socio-environmental factors did not appear as significant determinants independently. The implication of this is that in a homogenous and economically deprived society improvement in a single factor does not reduce the problem of diarrhoeal diseases. Hence, an inter-sectoral approach is recommended to control diarrhoeal diseases.

Outbreak of louse-borne relapsing fever in Jimma, south western Ethiopia.

Some epidemiological aspects of louse-borne relapsing fever during the epidemic of 1991 in Ethiopia are described. There was male preponderance and the age ranged from two months to 58 years (mean, sd = 18.05,11.19). There was no sex differential in children. Students, soldiers and jobless contributed the majority. There were two peaks (August and March) in the seasonal pattern. About two-thirds was infested with lice and significant associations were found among adults, soldiers, ethnicity, illiterate persons and family size above seven. The household attack rate was 15.1%, the attack being higher among children. Promotion of preventive measures are recommended.

Louse-borne relapsing fever in children.

Clinical manifestations of louse-borne relapsing fever (LBRF) in children admitted to Jimma Teaching Hospital from March 1991 to September 1991 are described. The clinical manifestations were mild and the frequency of occurrence of each feature was lower than in adults. Jaundice and cardiac abnormality have not been found in children. The Jarisch-Herxheimer reaction was also mild and occurred in about 16% of the cases. The prognosis of LBRF was excellent. Initial treatment with penicillin and continued treatment with tetracycline for a couple of days was justifiable. Further detailed studies with a larger series is recommended.