Fusarium diversity associated with the Sorghum-Striga interaction in Ethiopia.

Sorghum production is seriously threatened by the root parasitic weeds (RPWs) Striga hermonthica and Striga asiatica in sub-Saharan Africa. Research has shown that Striga control depends on eliminating its seed reserves in soil. Several species of the genus Fusarium (Nectriaceae, Hypocreales), which have been isolated from diseased Striga plants have proven to be highly pathogenic to all developmental stages of these RPWs. In the present study 439 isolates of Fusarium spp. were found associated with soils from Sorghum growing fields, Sorghum rhizosphere, or as endophytes with Sorghum roots and seeds, or as endophytes of Striga stems and seeds. Based on multi-locus phylogenies of combinations of CaM, tef1, rpb1 and rpb2 alignments, and morphological characteristics, 42 species were identified, including three species that are newly described, namely F. extenuatum and F. tangerinum from Sorghum soils, and F. pentaseptatum from seed of Striga hermonthica. Using a previously published AFLP-derived marker that is specific to detect isolates of F. oxysporum f.sp. strigae, an effective soil-borne biocontrol agent against Striga, we also detected the gene in several other Fusarium species. As these isolates were all associated with the Striga/Sorghum pathosystem, the possibility of horizontal gene transfer among these fusaria will be of interest to further investigate in future. Citation: Lombard L, van Doorn R, Groenewald JZ, Tessema T, Kuramae EE, Etolo DW, Raaijmakers JM, Crous PW (2022). Fusarium diversity associated with the Sorghum-Striga interaction in Ethiopia. Fungal Systematics and Evolution 10: 177-215. doi: 10.3114/fuse.2022.10.08.

Participatory identification of breeding objective traits and selection criteria for indigenous goat of the pastoral communities in Ethiopia.

A structured questionnaire, own-flock ranking experiment, and group discussions were undertaken to assess goat breeding practices and to identify traits of interest for genetic improvement of indigenous goats. Four pastoral villages in Ethiopia, namely, Jarso, Mesoya, Eleweya, and Dharito were selected based on their goat production potential, accessibility, and suitability to implement community-based breeding programs. A survey and flock ranking experiment involving 70 households and 199 goats were used. In flock ranking experiment, goat owners were asked to choose the first three superior and the worst doe within their own flock. They were also asked to provide their reason for ranking the animals. In addition, data on size traits, kid growth, kid survival, reproduction traits, and milk yield were recorded for each doe. Data obtained from questionnaire, flock ranking, and measurements were subjected to both qualitative and quantitative analysis. Large variation was observed between top and last ranked does in most of the traits and price, for example, in body weight (33.6 ± 0.88 vs. 25.2 ± 0.93 kg), doe's kid survival (92.1 ± 4.01 vs. 59.6 ± 4.48%) and doe's price (1367 ± 46.5 vs. 833 ± 46.9 (US$1 = 28.4 Ethiopian Birr) Ethiopian Birr). Mobility is practiced with a defined and known pattern; therefore, recruitment of mobile enumerators for data recording would assist in implementation of breeding programs. Breeding objective should emphasize mothering ability (kid growth and survival), milk yield of does, and coat color in all areas. Due to its good correlation with other traits like kid growth and pre-weaning kid survival, considering milk yield alone as selection criteria or giving more weight for milk yield in the breeding program could generate better genetic benefit. Setting-up breeding program should be based on full participation and context of pastoralists.

Sero-epidemiology of peste des petits ruminants in Oromia and Afar regional states of Ethiopia.

Peste des petits ruminants (PPR) is a severe non-zoonotic viral disease of small ruminants caused by a morbillivirus closely related to rinderpest virus (RPV). The disease is widespread in Africa, the Middle East and Southern Asia. It is one of the priority animal diseases whose control is considered important for poverty alleviation in those regions because of the associated high economic losses. A sero-epidemiological study of PPR was conducted in Oromia and Afar regional states of Ethiopia. A total of 800 serum samples from sheep and goats were collected between October 2015 and March 2016 in Afar and Oromia, where no vaccination history has been recorded. These two regions are known to have a large population of small ruminants. The levels of PPR antibodies obtained in the two regions using the competitive enzyme-linked immunosorbent assay (cELISA) ID Screen® PPR Competition from IDvet (Montpellier, France) were similar, at 12.7% and 13.0% for Afar and Oromia, respectively. A seroprevalence of 12.9% for the two regions was obtained. The study also linked seropositivity to risk factors such as sex, age and species with a p-value of less than 0.05 (p = 0.0001, p = 0.0001 and p = 0.004, respectively).

La peste des petits ruminants (PPR) est une maladie virale non zoonotique des petits ruminants due à un morbillivirus apparenté au virus de la peste bovine. Cette maladie est très présente en Afrique, au Moyen-Orient et en Asie du Sud. Elle fait partie des maladies animales prioritaires qu'il est important de contrôler à des fins d'allègement de la pauvreté dans les régions affectées, en raison de l'ampleur des pertes économiques qui lui sont associées. Une étude séroépidémiologique sur la PPR a été conduite en éthiopie, couvrant les régions d'Oromia et d'Afar. Au total, 800 échantillons sériques issus d'ovins et de caprins ont été prélevés entre octobre 2015 et mars 2016 à Afar et Oromia, régions sans historique documenté de vaccination. Les populations de petits ruminants y sont nombreuses. La détection d'anticorps dirigés contre le virus de la PPR au moyen de l'épreuve immuno-enzymatique de compétition (cELISA) ID Screen® PPR Competition du laboratoire IDvet (Montpellier, France) a fait apparaître un niveau d'anticorps comparable dans les deux régions (12,7 % à Afar et 13,0 % à Oromia). Le taux de prévalence sérologique pour les deux régions était de 12,9 %. L'étude a également permis de relier la présence d'anticorps à certains facteurs de risque tels que le sexe, l'âge et l'espèce, avec un degré de signification (p) inférieur à 0,05 (respectivement, p = 0,0001, p = 0,0001 et p = 0,004).

La peste de pequeños rumiantes (PPR) es una grave enfermedad viral no zoonótica que afecta a los pequeños rumiantes, causada por un morbilivirus estrechamente emparentado con el virus de la peste bovina. Esta patología, muy extendida en África, Oriente Medio y el sur de Asia, es una de las enfermedades animales prioritarias cuyo control se considera importante para paliar la pobreza en esas regiones, dado que engendra cuantiosas pérdidas económicas. Los autores describen un estudio seroepidemiológico de la PPR efectuado en los estados regionales de Oromia y Afar (Etiopía). Entre octubre de 2015 y marzo de 2016 se reunieron en total 800 muestras séricas de ovejas y cabras de Afar u Oromia, regiones donde no se tiene registrado antecedente alguno de vacunación y donde se sabe que hay una numerosa cabaña de pequeños rumiantes. En ambas regiones, con aplicación del ensayo inmunoenzimático de competición (ELISAc) ID Screen® PPR Competition de IDvet (Montpellier, Francia), se obtuvieron niveles similares de anticuerpos contra el virus de la PPR: del 12,7% en Afar y del 13,0% en Oromia. El cálculo arroja una seroprevalencia del 12,9% en ambas regiones. El estudio puso también de relieve la existencia de un vínculo entre seropositividad y tres factores de riesgo, el sexo, la edad y la especie, con valores de p inferiores a 0,05 (respectivamente, p = 0,0001, p = 0,0001 y p = 0,004).

Characterization of Staphylococcus aureus isolated from milk samples of dairy cows in small holder farms of North-Western Ethiopia.

BACKGROUND: Staphylococcus aureus is a contagious, opportunistic pathogen that causes clinical or subclinical mastitis in dairy cattle. The genetic background and antimicrobial resistance of isolates from Ethiopian dairy farms has not been studied. Therefore, the aim of this study was to characterize S. aureus from Ethiopian hand milked dairy cows, by spa, MLST and virulence factor typing, and by assessment of antimicrobial susceptibility. A total of 79 S. aureus isolates from intramammary infections was studied. A PCR was used to detect lukM-lukF' and pvl genes encoding the bovine and human associated bi-component leukocidins, and the toxic shock syndrome toxin gene-1 (tst). Antimicrobial susceptibility was determined using the broth microdilution method. RESULTS: Twenty different spa types were identified, most isolates were t042 (58%), and the closely related t15786 (11%). The proportion of isolates positive for lukM-lukF', tst and pvl was low at 0.04, 0.10 and 0.09 respectively, with lukM-lukF' often co-occurring with tst, but not with pvl. Methicillin-resistance was not found, but resistance to penicillin/ampicillin (86%) and tetracycline (54%) was very common. CONCLUSIONS: We found a high degree of relatedness among bovine S. aureus isolates in North-Western Ethiopia, suggesting contagious within and between farm transmission of strains that are often resistant to commonly used antimicrobials. This highlights the need for effective preventive measures that aim at limiting transmission of bacteria rather than using antimicrobials to control S. aureus mastitis in Ethiopia.

Detection of Equine Herpesvirus (EHV) -1, -2, -4 and -5 in Ethiopian Equids with and without Respiratory Problems and Genetic Characterization of EHV-2 and EHV-5 Strains.

Infections with equine herpesviruses (EHVs) are widespread in equine populations worldwide. Whereas both EHV-1 and EHV-4 produce well-documented respiratory syndromes in equids, the contribution of EHV-2 and EHV-5 to disease of the respiratory tract is still enigmatic. This study describes the detection and genetic characterization of EHVs from equids with and without clinical respiratory disease. Virus-specific PCRs were used to detect EHV-1, -2, -4 and -5. From the total of 160 equids with respiratory disease, EHV-5 was detected at the highest prevalence (23.1%), followed by EHV-2 (20.0%), EHV-4 (8.1%) and EHV-1 (7.5%). Concurrent infections with EHV-2 and EHV-5 were recorded from nine (5.2%) diseased horses. Of the total of 111 clinically healthy equids, EHV-1 and EHV-4 were never detected whereas EHV-2 and EHV-5 were found in 8 (7.2%) and 18 (16.2%) horses, respectively. A significantly higher proportion of EHV-2-infected equids was observed in the respiratory disease group (32/160, 20.0%; P = 0.005) compared to those without disease (8/111; 7.2%). EHV-2-positive equids were three times more likely to display clinical signs of respiratory disease than EHV-2-negative equids (OR 3.22, 95% CI: 1.42-7.28). For EHV-5, the observed difference was not statistically significant (P = 0.166). The phylogenetic analysis of the gB gene revealed that the Ethiopian EHV-2 and EHV-5 strains had a remarkable genetic diversity, with a nucleotide sequence identity among each other that ranged from 94.0 to 99.4% and 95.1 to 100%, respectively. Moreover, the nucleotide sequence identity of EHV-2 and EHV-5 with isolates from other countries acquired from GenBank ranged from 92.9 to 99.1% and 95.1 to 99.5%, respectively. Our results suggest that besides EHV-1 and EHV-4, EHV-2 is likely to be an important contributor either to induce or predispose equids to respiratory disease. However, more work is needed to better understand the contribution of EHV-2 in the establishment of respiratory disease.

Equine Herpesvirus-1 Myeloencephalopathy, an Emerging Threat of Working Equids in Ethiopia.

Although equine herpesvirus myeloencephalopathy (EHM) is a sporadic and relatively uncommon manifestation of equine herpesvirus-1 (EHV-1), it has the potential for causing devastating outbreaks in horses. Up till now, there were no reported EHM outbreaks in donkeys and mules. This study describes the isolation and molecular characterization of EHV-1 from clinically EHM-affected horses (n = 6), mules (n = 3) and donkeys (n = 82) in Ethiopia during outbreaks from May 2011 to December 2013. The incidence of EHM cases was higher from April to mid-June. EHM in donkeys was more severe and death without clinical signs of paralysis, and recumbency was frequently observed. The main age of affected equines ranged from 7 to 10 years (n = 51; 56.0%), and females (n = 58; 63.7%) were more affected than males. The incidence of neuropathogenic (D752 ) and non-neuropathogenic (N752 ) variants of EHV-1 from EHM-affected equines in Ethiopia was assessed by sequencing the DNA polymerase gene (ORF30) of the EHV-1 isolates. The results indicated that from the total of 91 clinically affected equines, 90 (98.9%) of them had an ORF30 D752 genotype. An ORF30 N752 variant was only found in one donkey. Analysis of ORF68 as grouping marker for geographical differences showed that the Ethiopian EHV-1 isolates belong to geographical group 4. Due to the fatal nature of EHV-1 in donkeys, it would be interesting to examine the pathogenesis of EHM in this species. At present, there is no vaccine available in Ethiopia, and therefore, outbreaks of EHV-1 should be controlled by proper management adaptations. In addition, it is important to test the efficacy of the commercial vaccines not only in horses, but also in donkeys and mules.

Indigenous knowledge of pastoralists on respiratory diseases of camels in northern Kenya.

The camel disease terminology of pastoralists in northern Kenya differentiates between two respiratory disease complexes of camels. Participatory epidemiology data were collected in 2011 in three camel keeping communities (Gabra, Garri, and Somali) and analysed to assess the validity of this differentiation. Further queries assessed recurrence of the disease in the same animal, most affected age group, relative frequency of occurrence, morbidity rates, mortality rates and response to antibiotic treatment. Based on matrix scoring the cardinal symptom nasal discharge was significantly correlated with Respiratory Disease Complex 1 (RDC1; Somali Hergeb, Gabra & Garri Furri) while cough was correlated with Respiratory Disease Complex 2 (RDC2; Somali Dhuguta, Gabra Qufa, Garri Dhugud). RDC1 appears to occur regularly every year and does not respond to antibiotic treatments while outbreaks of RDC2 are only observed at intervals of several years and treated cases do generally respond to antibiotics. While RDC1 is more severe in calves, RDC 2 is mostly associated with respiratory disease in adults. Elements of this differentiation appear to be in agreement with other authors who differentiate between camel influenza (PI3 virus) and bacterial camel pneumonia, respectively.

Changing risk of environmental Campylobacter exposure with emerging poultry production systems in Ethiopia.

Campylobacter is a leading cause of diarrhoea, and its presence in chickens is a significant risk for zoonotic infection. Poultry production is becoming increasingly intensive in Ethiopia and is incorporating more high-producing breeds into traditionally managed smallholdings, especially in peri-urban areas. This cross-sectional study sampled 219 household environments in one peri-urban and two rural areas of Ethiopia, and an additional 20 semi-intensive farms in the peri-urban district. Campylobacter was detected by polymerase chain reaction (PCR)-specific assays in 44 samples; 16 of which could be identified as C. jejuni. Flocks in the peri-urban area were at significantly greater odds of detection, including those which only kept indigenous birds under a scavenging system. It was also noted that scavenging flocks of exotic high-production birds (Rhode Island Red) were at slightly greater risk, perhaps as exotic birds are under more stress when kept under traditional management systems. We suggest that changes to the system of chicken production may alter the ecology and epidemiology of Campylobacter in the environment, chickens and people, which may drive emergence of new epidemiological patterns of disease. Further research is needed to determine the extent to which the current management intensification and the distribution programmes of exotic and/or improved indigenous birds may alter Campylobacter epidemiology, ecology and public health risk, before their widespread adoption.

Determination of Corynebacterium pseudotuberculosis prevalence and antimicrobial susceptibility pattern of isolates from lymph nodes of sheep and goats at an organic export abattoir, Modjo, Ethiopia.

UNLABELLED: Corynebacterium pseudotuberculosis is the causative agent of caseous lymphadenitis, a suppurative abscessation in the superficial and internal lymph nodes and internal organs of small ruminants. This study was conducted on the superficial lymph nodes and carcasses of 768 small ruminants slaughtered at a slaughterhouse during the study period; 82 had abscesses or caseous lymphadenitis. The most frequent sites of abscesses in goats were the prescapular (34, 5·54%) and prefemoral lymph nodes (24, 3·91%) respectively. Similar patterns were observed in sheep. The prevalence of caseous lymphadenitis was found to be significantly higher in adult than in young animals, in both species (P < 0·05). The age-wise prevalence rates of lesions on post-mortem inspection, at 95% CI, were 2·7% (2·3-3·1%) and 3·1% (2·8-3·4%) in young sheep and goats, respectively, and 24·4% (17·4-31·4%) and 27·5% (23·8-31·2%) in adult sheep and goats respectively. Corynebacterium pseudotuberculosis isolates were recovered from 72% (59/82) of animals found to have post-mortem evidence of abscesses. The Coryne. pseudotuberculosis isolates were susceptible to the antibiotics norfloxacin, tetracycline, doxycyline HCl and kanamycine; however, resistance was observed against ampicillin, clindamycin and doxycyline HCl. In conclusion, this study reported the magnitude of the problem in the country for the first time and the authors recommend a thorough investigation of wider study areas. SIGNIFICANCE AND IMPACT OF THE STUDY: This work presents data on the prevalence of caseous lymphadenitis in slaughtered sheep and goats as well as the isolation and antibiotic susceptibility pattern of Corynebacterium pseudotuberculosis for the first time in Ethiopia. The carcasses of small ruminants are the major livestock product exported from the country and serves as an important source of foreign currency. Assessing the impact of diseases such as caseous lymphadenitis in the industry would be of great significance. This work forms initial data that call for further wider investigations to gain complete understanding of its impact in the country.

Arginine as an adjuvant to chemotherapy improves clinical outcome in active tuberculosis.

Nitric oxide (NO) is involved in the host defence against tuberculosis (TB). Patients with TB exhibit increased catabolism and reduced energy intake. Thus the hypothesis for this study was that restoring a relative deficiency in the amino acid arginine, the substrate for mycobactericidal NO production, would improve the clinical outcome of TB by increasing NO production. In a randomised double-blind study, patients with smear-positive TB (n = 120) were given arginine or placebo for 4 weeks in addition to conventional chemotherapy. Primary outcomes were sputum conversion, weight gain, and clinical symptoms after week 8. Secondary outcomes were sedimentation rate and levels of NO metabolites, arginine, citrulline, and tumour necrosis factor-a. Compared with the human immunodeficiency virus (HIV)-/TB+ placebo group, the HIV-/TB+ patients in the arginine group showed significant improvement, defined as increased weight gain, higher sputum conversion rate and faster reduction of symptoms, such as cough. The arginine level increased after week 2 in the HIV-/TB+ arginine group (100.2 microM (range 90.5-109.9) versus 142.1 microM (range 114.1-170.1)) compared with the HIV-/TB+ placebo group (105.5 microM (range 93.7-117.3) versus 95.7 microM (range 82.4-108.9)). HIV seroprevalence was 52.5%. No clinical improvement or increase in serum arginine was detected in arginine supplemented HIV+/TB+ patients compared with placebo. Arginine is beneficial as an adjuvant treatment in human immunodeficiency virus-negative patients with active tuberculosis, most likely mediated by increased production of nitric oxide.

An evaluation of the diagnostic value of clinical and radiological manifestations in patients attending the addis ababa tuberculosis centre.

Our investigation is based on 1,000 consecutive patients attending the routine outpatient services of the Addis Ababa Tuberculosis Demonstration and Training Centre (ATBDTC) in Addis Ababa during the period November 1996-March 1997. By using sputum microscopy for acid-fast bacilli (AFB), chest radiography (CXR) and clinical assessment these patients had been diagnosed as having either AFB-positive pulmonary tuberculosis (PTB) (n = 139), AFB-negative PTB (n = 61) or non-tuberculosis (non-TB) (n = 800). These three diagnostic groups were subsequently re-assessed by us with regard to selected demographic and clinical parameters, including CXR, in order to identify and weight markers significantly linked to proven PTB. The sum of the individual weights provided diagnostic scores (DS); the average DS for AFB-positive patients was 653.5 +/- 174 and that for non-TB patients was 219.1 +/- 138.7. The calculated cut-off value between these two groups was 444. Ten (7.2%) AFB-positive PTB patents had a DS below the calculated cut-off, while 46 (5.8%) of the 800 non-TB cases had diagnostic scores exceeding this value. Our DS system achieved 92.8% sensitivity and 94.3% specificity, with positive and negative predictive values of 73.7% and 98.7%, respectively. When plotting the individual DS values of the 61 AFB-negative TB patients, 24 (39.3%) fell below the cut-off. It is most likely that these patients did not have PTB. We conclude that there is a need for improved and standardized diagnostic approaches for TB-suspected patients who depend upon clinical and CXR criteria for correct diagnosis. Our score system may be helpful in this context.

Diagnostic evaluation of urinary lipoarabinomannan at an Ethiopian tuberculosis centre.

Direct capture enzyme-linked immunosorbent assay (ELISA) for lipoarabinomannan (LAM) was performed on urine samples from 200 tuberculosis (TB) patients and 800 non-TB patients routinely diagnosed among consecutive suspects in an Ethiopian TB centre. 50 healthy Ethiopians, 50 healthy individuals and 100 non-TB patients from Norway served as controls. Of the TB patients, 139 (69.5%) were positive for acid-fast bacilli (AFB). In the remaining cases the diagnosis was based on suggestive clinical findings. All Ethiopian non-TB patients were AFB negative and showed no clinical evidence of TB. In the Ethiopian groups, 148 (74%) of the TB patients, 105 (13.1%) of the non-TB patients and 5 (10%) of the healthy controls were positive by the LAM-ELISA. 113 (81.3%) of AFB positives and 35 (57.4%) of AFB-negative TB patients had positive LAM-ELISA. In the Norwegian groups all were LAM negative. The sensitivity and specificity of the LAM-ELISA for TB patients versus Ethiopian non-TB patients were 74% and 86.9%, respectively; the positive and negative predictive values were 58.5% and 93.0%. This study suggests that detection of LAM in the urine of TB patients may improve case finding and that diagnostic tests based on this principle may serve as valuable supplemental tools in TB control.

Epidemiology of poliomyelitis in northwestern Ethiopia.

OBJECTIVES: To determine the magnitude of poliomyelitis and assess its epidemiological features. DESIGN: A cross-sectional community based, house-to-house survey. SETTING: Six urban and ten rural villages in Gondar Zuria district, north-western Ethiopia. SUBJECTS: Twelve thousand children aged 1-15 years residing in the randomly selected areas were enrolled in the study to identify children with walking abnormality. Paralytic poliomyelitis is considered as flaccid paralysis in one or both legs with normal sensations and acute onset without progression. RESULTS: Out of 12,000 children aged 1-15 years enrolled, 20 were found to have paralytic poliomyelitis. The prevalence of residual poliomyelitis was found to be 2.1 per 1000 children aged 1-15 years with the estimated annual incidence rate of 7.7 per 100,000 population. Sixty percent of the cases were from urban areas and 55% of the cases were males. CONCLUSIONS: The magnitude of paralytic poliomyelitis is high in the study area, thus expanding the expanded programme of immunizations with a strong surveillance system is suggested.

Childhood feeding practice in north Ethiopia.

Feeding practices among 1464 under fives were surveyed in the Gondar Zuria district of northern Ethiopia from July 1993 to May 1994. 99.8% of the children in the study area were breast fed initially, 5% discontinued before six months of age and 15% before the end of their first year of life. The mean duration of breast feeding was 21.97 +/- 10.15 months. Supplementary diet was initiated between 4-6 months in 42.4% of the children while in 16% it was started beyond the first year of life. The mean age of starting supplementary feeding was 9.9 +/- 6.5 months. The most frequently used supplementary diet was the staple diet which has a low nutritious value. The study revealed that initiation of breast feeding is not a problem in Ethiopia and the major areas of concern are the early termination of breast feeding, the delay in initiation of supplementary diet and the low quality of supplementary diet. Proper and sustained education of parents on feeding infants and children needs continuing emphasis.

PIP: The feeding practices of infants and children play key roles in the prevalence of malnutrition, one of the major causes of morbidity and mortality in developing countries. The feeding practices of 1464 children under age 5 years in the Gondar Zuria district of northern Ethiopia were surveyed between July 1993 and May 1994. 99.8% of the children in the study area were initially breast fed, but 5% discontinued before age 6 months and 15% before reaching age 1 year. The mean duration of breast feeding among the children was 21.97 months. A supplementary diet was introduced at age 4-6 months in 42.4% of the children, while in 16% it was started after age 1 year. Supplementary feeding began at the mean age of 9.9 months. The most frequently used supplementary diet was the local staple, yet low nutrition diet. These findings indicate that while there is no problem in Ethiopia with women initiating breast feeding, the early termination of the practice, the delay in beginning a supplementary diet, and the low quality of the supplementary diet are of concern.

Performance of health workers after training in integrated management of childhood illness in Gondar, Ethiopia.

The performance of six primary health workers was evaluated after following a 9-day training course on integrated management of childhood illness (IMCI). The participants were selected from three primary health centres in the Gondar District, Ethiopia, and the course was focused on assessment, classification, and treatment of sick children (aged 2 months to 5 years) and on counselling of their mothers. Immediately following this training, a 3-week study was conducted in the primary health centres to determine how well these workers performed in assessing, classifying and treating the children and in counselling the mothers. A total of 449 sick children who presented at the three primary health centres during the study period were evaluated. Most of the complaints (87%) volunteered by the mothers (fever, cough, diarrhoea, and ear problems) were covered by the IMCI charts. The assessment of commonly seen signs (tachypnoea or ear pain) or easily identifiable signs (slow return after skin pinch, wasting, or pedal oedema) was good, with sensitivities of 67-91%, whereas the assessment of uncommonly seen signs (dry mouth, corneal clouding) or less easily quantifiable signs (eyelid pallor, absence of tears) had a fair or poor sensitivity of 20-45%. The classification of pneumonia, diarrhoea with signs of dehydration, and malnutrition showed sensitivities of 88%, 76%, and 85% and specificities of 87%, 98%, and 96%, respectively. However, the classification of febrile illnesses had a sensitivity of only 39% due to problems in using the draft algorithm in areas with a mixture of high, low, and no malaria risk, and due to confusion between axillary and rectal temperature thresholds. Of 39 children classified as having severe disease, 9 were misclassified, mostly by one nurse. Treatment of patients improved over the three weeks of observation, their completeness increasing from 69% to 88%. Health workers usually communicated appropriate advice to the mother. They learned to use checking questions but failed to adequately solve problems in the majority of cases. The mother's counselling card, which summarized recommendations on feeding and home fluids, and advice on when to return, was widely used to aid communication. The time taken to perform the complete management of children did not change significantly (20 to 19 minutes) during the study. Lessons from our findings have been incorporated into an improved version of the IMCI charts.

PIP: 6 outpatient clinic nurses selected from 3 primary health centers in the Gondar District of Ethiopia were trained over the course of 9 days in the integrated management of childhood illnesses (IMCI), after which their performance was evaluated. The training course focused upon the assessment, classification, and treatment of sick children aged 2 months to 5 years, and upon the counselling of their mothers. Immediately following the training, the trainees were observed working in the health centers for a 3-week period to determine how well they assessed, classified, and treated children, and counseled mothers. 449 children who presented at the centers during the study period were evaluated. 87% of the complaints noted by the mothers on fever, cough, diarrhea, and ear problems were covered by the IMCI charts. There was good assessment of commonly seen signs such as tachypnoea and ear pain, as well as of readily identifiable signs such as a slow return after skin pinch, wasting, and pedal oedema; sensitivities were 67-91%. However, sensitivities were only 20-45% for rarely seen signs such as dry mouth and corneal clouding and the more difficult to recognize signs of eyelid pallor and the absence of tears. The classification of pneumonia, diarrhea with signs of dehydration, and malnutrition had sensitivities of 88%, 76%, and 85%, and specificities of 87%, 98%, and 96%, respectively. The classification of febrile illnesses was 39% sensitive. 9 of 39 children with severe disease were misclassified, mostly by one nurse. Patient treatment improved over the 3 weeks of observation and health workers usually communicated appropriate advice to mothers.

Anthropometric study of Ethiopian pre-school children.

A community based cross sectional anthropometric study was conducted to assess the nutritional status of children under 5 years of age in north western Ethiopia. One thousand four hundred and twenty two children were enrolled in the study. Stunting which is expressed by height for age below -2 standard deviation (SD) was seen in 43% of the children. The prevalence of wasting which is expressed by weight for height below -2 SD was 9%. The highest percentages of stunting and wasting were found in the age group 12-23 months. Compared with the national Center for Health Statistics (USA)/World health organization (NCHS/WHO) reference data all the indicators were shifted to the left. Urgent nutritional rehabilitation for those that are wasted, proper nutritional education for reducing the high prevalence of malnutrition and identifying risk factors for the poor nutritional status is suggested.

Congenital malformations in Gondar Hospital, Ethiopia.

A retrospective record analysis of the last six years was done to determine the pattern of congenital malformations in the paediatrics department of Gondar College of Medical Sciences Hospital, North Gondar, Ethiopia. Of a total of 7489 admissions, 191 cases of congenital malformations were found, accounting for about 2.6% of the total admissions. The male to female ratio was 2.7:1. Cardiac malformations were seen more frequently (31%) followed by hernias (15.7%) and gastrointestinal malformations (14.8%). In only 45% of the cases were medical care sought in the first year of life. Out of 191 cases, 20 died in which the malformations were directly or indirectly accountable, giving a case fatality rate of around 10.5%. This study has highlighted the need for a community based, large scale prospective study to determine the incidence and contributory factors for congenital malformations.

Risk factors for the development of diarrhoea in the neonatal ward of Ethio-Swedish Children's Hospital.

A retrospective case control study was made to determine the risk factors for development of diarrhoea in a neonatal ward of Ethio-Swedish Children's Hospital over a period of 12 months. A total of 803 neonates' record was screened for the presence of diarrhoea during their hospital stay. There were 79 cases with an attack rate of 9.84%. The identified risk factors are gestational age less than 37 weeks, birth weight of less than 2500 gms, formula feeding and hospital stay of more than 10 days. Prophylactic usage of antibiotics have proven to be non-beneficial in reducing the acquisition of diarrhoea. Anticipation of the problem in those that are at risk and persistent surveillance to detect cases would be of paramount importance in reducing the overall morbidity.

PIP: 803 patients' records, comprising all admissions in the neonatal ward of Ethio-Swedish Children's hospital over 12 months, were analyzed. Data were collected regarding date of admission, age at admission, sex, place of birth, gestational age, birth weight, history of premature rupture of membrane, mode of delivery, and Apgar score. Cases were neonates in whom diarrhea was treated; controls were the remaining patients admitted in the same time interval. 79 (9.84%) of 803 neonates studied had diarrhea during hospitalization. The cases were highest in April (n = 14), while in August 25% of neonates had diarrhea. The highest number of admissions were in January (98) and February (93), when there were only 7 and 9 cases, respectively. About 95% of the neonates were born in a health institution and 73.7% of the neonates were admitted within the first 24 hours. 59% of the neonates were male; 41% were females. 81% were delivered vaginally. Antibiotics were administered at admission for 88% of the neonates, and in 30% of the neonates there was a history of premature rupture of membrane. 51.9% of the cases had a gestational age of less than 37 weeks, in comparison to 39.4% of controls (p 0.05 with an odds ratio [OR] of 1.64). 64.6% of cases were below 2500 gm in weight, whereas 49.2% of the controls were less than 2500 gm in weight (p 0.05, OR of 1.87). Expressed breast milk and formula milk feeding together was found in 645 (80.3%) of all admissions. 92% of the cases were on expressed breast milk or formula compared to 60.7% of controls (p 0.01, OR of 7.45). 51% of the cases vs. only 29% of the controls were formula fed (p0.01, OR of 2.48). The administration of antibiotics for various indications lasted for 10 days for the majority of neonates admitted. 86% of the cases had stayed for more than 10 days in contrast to 28% of the controls (p 0.01, OR of 15.43).

Relapsing fever in children--demographic, social and clinical features.

Louse-borne relapsing fever (LBRF) is an acute febrile illness endemic Ethiopia. To date reports of childhood LBRF are few. The demographic, social and clinical features of eighty children with LBRF admitted to Ethio-Swedish Children's Hospital, Addis Abeba between 1989 and 1991 is presented. The mean age of patients was 8.8 years (range 4 months to 15 years). The male to female ratio was 1.2:1. Seventy-seven (97%) patients came from Addis Abeba. They came from poor families living in overcrowded homes. Fever, headache, right upper quadrant pain, chills and rigors were common symptoms. Fever and hepatosplenomegaly were common signs. Three drug regimens were used in the treatment of patients. A combination of penicillin and tetracycline, chloramphenicol alone and erythromycin alone, all given for 3 days. There was only one death. The literature on LBRF in adults is reviewed and the results are compared (1).