Immunization coverage and identification of problems associated with vaccination delivery in Gondar, north west Ethiopia.

A cluster sample survey using the Expanded Programme for Immunization (EPI) methodology was conducted in April 1995 in Gondar town and surrounding villages in north west Ethiopia to assess immunisation coverage in the area and problems associated with vaccination delivery. Two hundred and thirteen children aged 12-24 months were enrolled into the study from the chosen thirty clusters. Among the sampled children, 101 (47.4%) were fully immunised while 64(30%) were not immunised at all. Only 38% of the mothers had received tetanus toxoid vaccination more than once. Reasons given for not immunising a child were lack of knowledge (39.8%), social problems (38.7%) and various obstacles (22.8%), such as child sickness and health institution related problems. A strategy of strengthening of health education, primary health care and extension of the eligibility criteria are suggested as solutions to improve coverage.

PIP: This study determines the extent and nature of immunization of children and mothers in rural Ethiopia. Data were obtained from a sample of 213 children from visits to 1269 households in Gondar town and surrounding rural villages in northwest Ethiopia in April 1995. 80.3% of respondents were mothers, 7.5% were fathers, and the rest were grandparents or other relatives. 49.3% of children were females. The mean age of children was 18.2 months. 85.9% were Christians, and 14.1% were Muslims. 62% of children were delivered at home, 28.2% were delivered at a hospital, 5.6% were delivered at a health center, and 3.8% were delivered at a health station. 47.4% of the children were fully immunized; 30.0% were not immunized at all; 22.6% were partially immunized. 56% received immunizations at outreach posts. 5.2% did not believe that immunization was useful. 91.7% believed that immunization prevented disease. 3.9% believed that immunization cured disease. 3.4% believed that immunization made symptoms milder. Many knew that measles and pertussis were prevented by vaccines. Fewer were aware of the prevention of tetanus and poliomyelitis. 15.4% believed that vaccines prevented tuberculosis. 21.6% of mothers were immunized at least once; 22.5% were immunized twice; 8.5% were immunized three to four times; 7% were immunized five times; and 40.4% were never immunized. Polio coverage was the lowest among children, because many were delivered at home and did not receive immunization at birth as recommended by WHO. The reasons given by mothers for the lack of immunization or incomplete immunization included: lack of knowledge, unawareness of the need for second and third doses and measles protection, and a belief that disease is better than immunization. Other common reasons were social problems and lack of time.

Antibiotic resistance of prevalent Salmonella and Shigella strains in northwest Ethiopia.

Salmonella and Shigella strains were isolated prospectively from in- and outpatient specimens of the Gondar College teaching hospital over a two year period, from June 1994 to May 1996. Of 7993 miscellaneous specimens cultured, 80 yielded Salmonella and 147 Shigella. Serogroup B dominated among the salmonella, accounting for 61% of isolates, followed by S. typhi (21%). S. flexneri (58.5%) and S. dysenteriae (36.7%) were the most frequently isolated species among the Shigella. Results of sensitivity testing to five commonly used antibiotics in the area: ampicillin, chloramphenicol, gentamicin, tetracycline and cotrimoxazole, showed multiple drug resistance among the isolates of both salmonella and shigella. Only 4% of shigella were sensitive to all five antibiotics screened for in the study. Overall sensitive of shigella isolates to individual antibiotics was 8.8% to tetracycline, 10% to ampicillin, 28% to co-trimoxazole and 98% to gentamicin. No resistance was observed to nalidixic acid among 108 shigella strains tested for this antibiotic. The continued sensitivity of S. typhi to chloramphenicol, cotrimoxazole, ampicillin and the other commonly used antibiotics is noted. It is recommended that nalidixic acid be introduced into the area under strict regulation for treatment of severe cases of shigella dysentery, an illness which is highly endemic in the region and the cause of occasional epidemics with high mortality.

Campylobacter enteritis among children in north-west Ethiopia: a 1-year prospective study.

The incidence of campylobacter enteritis among children visiting the outpatient department of a teaching hospital in north-west Ethiopia was prospectively studied over a period of 12 months from June 1994 to May 1995. Campylobacter spp. were isolated from the stools of 60 children out of 434 investigated by culture (13.8%). The highest isolation rate was found in children aged from 6 to 24 months. The period of peak isolation was September to November. Among children aged 1-5 years, campylobacter was more frequently isolated from those presenting with persistent diarrhoea than from among those with acute illness (OR 2.53; 95% CI: 1.02-6.18). Culture positivity was higher among malnourished children. Our findings demonstrate the important role played by this pathogen in childhood diarrhoeal illness in the area.

Pyogenic meningitis in children in north-western Ethiopia.

A 5-year retrospective study of all children with acute pyogenic meningitis admitted to a district hospital in north-western Ethiopia was carried out from 1990 to 1994. A total of 132 cases of pyogenic meningitis were identified. The causative bacteria were identified in 85 (64%) patients. The most common pathogen was Haemophilus influenzae (40%) with a case fatality rate of 29.4%, followed by Neisseria meningitidis (36.4%), which had a case fatality rate of 16.1%, and Streptococcus pneumoniae (20%) with a case fatality rate of 35.3%. Boys accounted for 64% of the patients, giving a male:female ratio of 1.7:1. Median patient age was 0.75 years, and median ages of those infected by H. influenzae, N. meningitidis, and S. pneumoniae were 0.5, 4.0 and 0.6 years, respectively. The overall case fatality rate was 28%. The mortality rate of children below the age of 1 year was 38.4% and 13.8% for those above 1 year.

Accidental injuries among children in north-west Ethiopia.

A retrospective analysis of admissions due to unintentional injuries in children was conducted over a five year period (1988-1993) in a teaching hospital in north-western Ethiopia. Injuries accounted for 341 (4.8%) of 7055 admissions due to all causes in this period. Of 313 children whose data were analysed, 228 (63%) were male. The causes of injury were firearms (25%), falls (22%), burns (16%) and motor vehicle accidents (14%). Highest case fatality rates were found in foreign body aspiration (40%), burns (35%) and falls (22%). Most children who presented with burns had more than 15% body surface area affected on admission. Poisoning accounted for 6.8% of admissions and was mostly due to malathion. Animal related injuries accounted for less than 3% of the unintentional injury admissions. This is the first report on childhood injuries from the Gondar area.

Postnatal development of urea- and ammonia-excretion in urine of very-low-birth-weight infants small for gestational age.

In 12 very-low-birth-weight (VLBW) infants with intrauterine growth retardation and in 14 VLBW-infants appropriate for gestational age (AGA) fed a human milk (HM) formula (HM enriched with 6 g freeze dried HM per 100 ml) the renal excretion of urea and ammonia was studied on the 10th, 21st and 42nd days of life. The lowest excretion of urea was found in both groups on the 10th day of life. Up to the 42nd day of life the excretion raised significantly more in the AGA- than in the small for gestational age (SGA)-infants. In contrast to the urea excretion the excretion of ammonia was highest on the 10th day of life in both groups, but the excretion was significantly higher in the SGA-infants if compared to the AGA-infants. In the AGA-infants excretion of ammonia decreased with postnatal age whereas in the SGA-infants the high excretion remained up to the 42nd day of life. The data suggest that in VLBW-infants the urea synthesizing capacity is decreased and develops within the first weeks of postnatal life. The postnatal development is delayed in SGA-infants when compared to AGA-infants. The differences are more pronounced with increasing degree of intrauterine growth retardation.

Relationship between urea and ammonium excretion in the urine of very-low-birth-weight infants appropriate for gestational age.

In 14 very-low-birth-weight infants appropriate for gestational age the serum concentrations of urea and the excretions of urea and ammonium in the urine were studied on the 10th, 21st, and 42nd day of postnatal life. All infants were fed with a human milk preparation (6 g human milk lyophilisate per 100 ml fresh human milk). The enteral feeding could be started on the first day of life so that protein intakes were not different on the three study days (2.94 vs. 2.98 vs 3.13 g/kg.d). The renal excretion of urea increased significantly from the 10th to the 42nd day of life (1.2 +/- 0.13 vs 2.1 +/- 0.24 mmol/kg.d) whereas the excretion of ammonium decreased during the same time (0.53 +/- 0.06 vs 0.29 +/- 0.05 mmol/kg.d). There was a significantly negative correlation between the excretion of urea and of ammonia on all study days. The weight gain was sufficient for the given protein intakes (18.9 +/- 3.4 g/kg.d). The results indicate a transient limited capacity of the urea synthesizing system in the liver of very-low-birth-weight infants during the first weeks of life which should be considered if metabolic responses to protein intake are studied and evaluated in these infants.