Male involvement in prevention of mother-to-child transmission of HIV in the context of partner testing in Goba town, Ethiopia: A facility-based cross-sectional study.

BACKGROUND: Antenatal care (ANC) is an entry point for the prevention of mother-to-child transmission (PMTCT), particularly when a man accompanies his spouse for voluntary counselling and testing (VCT), even though this seldom happens in Ethiopia. OBJECTIVE: To study the role of male partners in improving PMTCT/ANC, which is essential to prevent HIV/AIDS transmission in this country. Our study focused on identifying barriers for the low involvement in PMTCT/ANC among male partners whose spouses received ANC. METHODS: A total of 422 male partners in Goba town, Oromia regional state, Ethiopia, were recruited in September - October 2014 and enrolled by a systematic sampling method. A facility-based cross-sectional study and two focus group discussions (FGDs) were conducted. Binary logistic regression and odds ratios were calculated to ascertain sociodemographic and other important information compared with the outcome variable and PMTCT/ANC, while the findings of the FGDs were grouped according to the emerging themes and analysed manually by means of a thematic approach. RESULTS: The percentage of male partners (22.7%) accompanying their spouses for HIV testing and counselling at antenatal clinics improved three-fold when an invitation letter was introduced as a new initiative to increase male participation. Individuals in the age group 15 - 29 years (adjusted odds ratio (AOR) 5.4, 95% confidence interval (CI) 1.66 - 17.85), and whose duration of marriage was ˂5 years (AOR 5.6, 95% CI 1.83 - 17.30), were more likely to be tested than their referent groups. Men without a higher education (AOR 0.1, 95% CI 0.02 - 0.50), who disagreed with legal enforcement (AOR 0.1, 95% CI 0.07 - 0.32), were less likely to be tested, while those who did not notify their partners (AOR 8.4, 95% CI 1.92 - 37.12) were more likely to use the service. Being busy, proxy testing, fears of testing HIV-positive, neglecting the importance of VCT, and inadequate knowledge about the PMTCT/ANC programme were other barriers that came to the fore in the FGDs. CONCLUSION: Identified barriers have to be addressed, and helpful practices, such as using invitation letters to increase the uptake of the service by male partners, have to be instituted.

Male involvement in prevention of mother-to-child transmission of HIV in the context of partner testing in Goba town, Ethiopia: A facility-based cross-sectional study

Background. Antenatal care (ANC) is an entry point for the prevention of mother-to-child transmission (PMTCT), particularly when a man accompanies his spouse for voluntary counselling and testing (VCT), even though this seldom happens in Ethiopia.Objective. To study the role of male partners in improving PMTCT/ANC, which is essential to prevent HIV/AIDS transmission in this country. Our study focused on identifying barriers for the low involvement in PMTCT/ANC among male partners whose spouses received ANC.Methods. A total of 422 male partners in Goba town, Oromia regional state, Ethiopia, were recruited in September - October 2014 and enrolled by a systematic sampling method. A facility-based cross-sectional study and two focus group discussions (FGDs) were conducted. Binary logistic regression and odds ratios were calculated to ascertain sociodemographic and other important information compared with the outcome variable and PMTCT/ANC, while the findings of the FGDs were grouped according to the emerging themes and analysed manually by means of a thematic approach.Results. The percentage of male partners (22.7%) accompanying their spouses for HIV testing and counselling at antenatal clinics improved three-fold when an invitation letter was introduced as a new initiative to increase male participation. Individuals in the age group 15 - 29 years (adjusted odds ratio (AOR) 5.4, 95% confidence interval (CI) 1.66 - 17.85), and whose duration of marriage was ˂5 years (AOR 5.6, 95% CI 1.83 - 17.30), were more likely to be tested than their referent groups. Men without a higher education (AOR 0.1, 95% CI 0.02 - 0.50), who disagreed with legal enforcement (AOR 0.1, 95% CI 0.07 - 0.32), were less likely to be tested, while those who did not notify their partners (AOR 8.4, 95% CI 1.92 - 37.12) were more likely to use the service. Being busy, proxy testing, fears of testing HIV-positive, neglecting the importance of VCT, and inadequate knowledge about the PMTCT/ANC programme were other barriers that came to the fore in the FGDs.Conclusion. Identified barriers have to be addressed, and helpful practices, such as using invitation letters to increase the uptake of the service by male partners, have to be instituted

Adolescents' undernutrition and its determinants among in-school communities of Ambo town, West Oromia, Ethiopia.

BACKGROUND: Adolescence is the most important period of life where growth and development are accompanied by various physical, physiological, behavioral, and social changes leading to increased demand for nutrients which could pose a greater risk of malnutrition. OBJECTIVES: To assess the magnitude of adolescents' undernutrition and its determinants in public schools of Ambo town. METHODS: A cross-sectional study design with analytical component was conducted between March 20 and April 10, 2008. A total of 425 in-school adolescents were assessed for their nutritional status. Weight, height and other important socio-demographic and dietary information were taken using pre-tested questionnaire. Body Mass Index (BMI) was computed and compared to the reference standards. RESULTS: The overall prevalence of underweight and overweight was 27.5% and 4.3% respectively. The proportion of underweight was higher in males (29.8%) than females (24.6%) while overweight were higher in females (4.9%) than males (3.8%). However, the difference noted was not significant (P = 0.4). Underweight was significantly higher in early (38.1%) than late (18.6%) adolescent (p = 0.001). The most important predictors identified for underweight were adolescent's age, menarche onset, food source for consumption and family possession of cattle (p < 0.05). CONCLUSION: Underweight in the in-school adolescents is prevalent. To help adolescents build better futures with more civic education and life skills, an integrated nutrition and health related services that meet the needs of adolescents in the school community is recommended.

Utilization of antenatal care services among teenagers in Ethiopia: a cross sectional study

Background: Teenaged women suffer from a disproportionate share of reproductive health problem. The purpose of this study was to estimate the utilization of antenatal care (ANC) services among teenagers (13-19 years) during delivery in Ethiopia. Methodology: Raw data collected from all part of the country on child bearing aged women using stratified cluster sampling method by the Ethiopian Demographic Health Survey 2005 was used. From the large dataset of women; a total of 994 teenage women at the time of their most recent childbirth five years prior to the survey was selected and analyzed. Both bivariate and multivariate analyses were performed to determine the differentials of ANC by explanatory variables. Result: Most (60) of the subjects were in the age group between 18 and 19 years. The vast majority (90) was from the rural settings and most (87) were in marital union. Almost three out of four (72.4) of those who had given birth has no any form of formal education. Over a quarter (27.3) of most recent childbirths had at least one ANC service; of this; 21had started their first antenatal visit in the first trimester of pregnancy. The majority (80.4) of the women who attended ANC delivered at home without being assisted. The major deriving factors for the utilization of ANC service were education level of women and their male partners; better wealth index and urban residence. Conclusion: Education of partners; rich wealth index and urban residence seemed to encourage teenagers to utilize ANC. Appropriate interventions targeting teenaged women with poor socioeconomic status is recommended with more emphasis on the rural underserved segment of population. [Ethiop. J. Health Dev. 2010;24(3):221-225]

Gender differences in the household-headship and nutritional status of pre-school children.

BACKGROUND: In genera self declared female headed-households in most developing countries tend to be poorer, own less and have less access to job opportunities. OBJECTIVE: To assess the nutritional status of pre-schoolers by gender differentiation of heads of households. DESIGN: A cross-sectional descriptive study carried out in February 2003. SETTING: Four beneficiary villages registered under the Ethio-Danish joint community development programme in North Ethiopia. SUBJECTS: A total of 144 heads of random systematically selected households regrouped as male-headed (n = 96) and female-headed households (n = 48) with their respective preschoolers. MAIN OUTCOME MEASURES: Nutritional status of two groups of children categorised by gender of the head of household. RESULTS: The number of pre-schoolers from male-headed households was 1.54 as opposed to the female-headed households (1.08). The proportion of stunted and underweight pre-schoolers was significantly higher in female headed-households than in the male-headed households while the prevalence of wasting was practically similar. The proportion of vaccinated and breastfed children, although not statistically significant, was higher in male headed households while the practice of colostrums feeding, giving water and butter, vitamin A and appropriate weaning was better in female headed households. The difference noted in prevalence of feeding colostrums was significant. The energy, protein and vitamin A intake in almost all of the households was below the recommended daily allowances; showing a nutrient adequacy ratio of 50.2%, 48.8% and 17.9% respectively whereas iron intake exceeded 100%. The energy, protein, vitamin A and iron intake was better in the male-headed households than in female-headed households. The difference, however, was statistically significant for energy only. CONCLUSION: This study delineated that chronic child under-nutrition is not only higher among female children but also in female headed households and hence the implication of gender biased violation of the right to nutrition security. Other important implication of this study is that apart from gender issues alternative livelihood options that promote healthy behaviours, such as, improving the provision of health services and curbing the harmful traditional practices that may have a dual impact on the well being of mothers and children is recommended.

Iron Deficiency Anaemia among Women of Reproductive Age in Nine Administrative Regions of Ethiopia

Background: Iron deficiency anaemia (IDA) is one of the most common causes of nutritional problem; and is of great public health significance affecting children; adolescents and women of reproductive age world wide. The magnitude of IDA in the general population of Ethiopia has not yet been well documented. Objective: To estimate the magnitude of IDA among women of reproductive age in nine administrative regions. Methods: A cross-sectional study of analytical nature was conducted in 270 clustered villages drawn from 9 administrative regions of the country between June and July 2005. A total of 22;861 women of reproductive age (15-49 years) were examined clinically for pallor and 5of these subjects were systematically selected and assessed further for their haemoglobin (Hgb) and serum ferritin (SF) status. Results: The prevalence rate of clinical anaemia; anaemia; ID (iron deficiency) and IDA were 11.3; 30.4; 49.7and 17.0respectively. The majority of anaemic women were in the category of mild (19.3) to moderate (10.3) and severe anaemia was 0.9. A significantly higher proportion of clinical anaemia [26.7(95CI: 24 to 28)]; anaemia (Hgb) [79.4(95CI: 72 to 86)]; ID [65.1(95CI: 72 to 86)] and IDA [58.0(95CI: 55 to 76)] was observed in Afar signifying distinct regional variation. The most affected age groups were those between 36-49 years and the difference noted was statistically significant. Conclusion: This study substantiates the existence of mild to moderate form of IDA among women of reproductive age and underlines the need for iron supplementation to all reproductive women during the antenatal period with more attention to the most affected regions

Determinants of exclusive breastfeeding practices in Ethiopia

Background: Despite the demonstrated benefits of breast milk; the prevalence of breastfeeding; in-particular exclusive breastfeeding (EBF); in many developing countries including Ethiopia is lower than the international recommendation of EBF for the first six months of life Objective: To assess the practice of EBF and explore its determinants in Ethiopia and provide policy makers and NGOs with relevant information for future planning and interventions. Methods: Raw data collected from nine regions and two city administrations using stratified cluster sampling method by the Ethiopian Demographic Health Survey (EDHS) 2005 were used to study the practice and determinants of EBF countrywide. Analysis was based on children whose age was less than six months and alive at the time of interview that was extracted from the women's database. Results: The overall rates of exclusive and full breastfeeding were 49.0and 68.2respectively. Maternal education; marital status; wealth index and age of the child were closely associated with EBF practices; nonetheless; in the hierarchical analysis; being not married; middle/ richer/ richest wealth index; and child age 0-1and 2-3 month were retained as the predictors of EBF (P0.05). Conclusion: A range of maternal and child health attributes such as marital status; economical status and child age were found to influence the practice of EBF in Ethiopia. Actions to empower women and promotion of EBF campaignare recommended to achieve the fourth millennium development goal

Infant Feeding Practice of HIV Positive Mothers and its Determinants in Selected Health Institutions of Addis Ababa; Ethiopia

Background: Avoidance of all breast-feeding by HIV infected mothers is recommended when replacement feeding is acceptable; feasible; affordable; sustainable; and safe. Whereas for women whose HIV status is unknown or negative; exclusive breastfeeding for the first six months is the single infant feeding option recommended. Objective: To assess the infant feeding practice of HIV positive mothers and its determinants. Methods: A cross sectional study with analytical component was conducted in 13 purposively selected health institutions with ART and PMTCT facilities in Addis Ababa during March; 2008. A total of 327 HIV positive mothers with their young infants visiting the respective health institutions were recruited in order of arrival; and assessed for their infant feeding practices. Results: Exclusive replacement feeding (ERF); exclusive breastfeeding (EBF) and mixed feeding (MF) were 46.8; 30.6; and 15.3respectively. The predictors for choosing ERF were mode of delivery (p0.05); household income (p0.05) and disclosure of HIV status to spouse (p0.01). The predictor for EBF; was mode of delivery (p0.05) while for MF; disclosure of HIV status to spouse (p0.05); parental infant feeding attitude (p0.01) and infant illnesses (p0.01) were the predictors. Furthermore; sticking to mothers' informed safer feeding options is challenged by some social factors. Conclusion: The present study delineated the predictors involved in making safer choices for infant-feeding options. To achieve success in exclusivity of feeding options; mothers' decision should be respected and pressure from the family/neighbors to introduce other food to the infant needs to be discouraged. Furthermore; the risks involved in each infant feeding option should be communicated and advocated to the mother/father during PMTCT to make informed choices

VCT Uptake and Associated Factors among Teachers from Harari Administrative Region

Background: Although HIV/AIDS is affecting most productive segments of the population; the basic education sector which is vital to the creation of human capital is also equally affected. The loss of skilled and experienced teachers due to the problem is increasingly compromising the provision of quality education in most African countries and thus; needs appropriate intervention measures that reverse the current trend. Objectives: To assess the prevalence and determining factors of VCT uptake among teachers of Harari Administrative Region. Methods: A cross sectional study design with analytic component was conducted among 566 teachers drawn from 20 randomly selected schools of Harari Administrative Region from March to April 2009. Self administered questionnaire; adapted from previous relevant studies was used to estimate the prevalence of VCT uptake and the various socio-demographic and psychological factors. Data were entered and analyzed using bi-variate and multivariate models. Results: A total number of 497 teachers responded to the questionnaire adequately making the response rate of 87.8. The mean age of the participants was 34.68 ranging from 18 - 61 years. There were more teachers from urban areas (72.0) and most of them were males (62.2). About half (54.1) were married and few (5.2) were divorced. The vast majority (98.6) heard about the confidential VCT service and their major sources of information were mass media (85.3) and health workers (56.2). The prevalence of VCT uptake was 46.3. The odds of utilizing VCT significantly increased with being younger age group; female and first and second cycle teachers' category.Conclusions: The major factors identified for increased uptake of VCT are gender; age and salary category. Actions targeting the males; non-youth age group and low grade teachers' are necessary to follow their peer groups to utilize the VCT service in order to achieve the goal of education set for 2015

Effect of iron supplementation on serum zinc status of lactating women in Addis Ababa, Ethiopia.

OBJECTIVE: To evaluate the impact of daily and weekly iron supplementation on serum zinc status among anaemic lactating mothers. DESIGN: A randomised iron intervention controlled trial. SETTING: Seven urban slum communities of Addis Ababa. SUBJECTS: Phase one of the study involved 207 anaemic lactating women assigned into two intervention groups; the daily (N=71) and weekly (N=71) Iron supplemented and the control group (N=68). Supplementation with 60 mg tablet containing 300 microg ferrous sulphate and 400 microg folic acid was done for three months while the control group was n otsupplemented. Phase two involved 53 participants systematically drawn from phase one. MAIN OUTCOME MEASURES: Haemoglobin from all subjects and serum zinc and ferittin levels following three months supplementation. Zinc status based on serum zinc value of less than 10.7% micromole/L. RESULTS: The mean baseline characteristics and serum zinc of the women at baseline were similar, overall marginal zinc deficiency prevalence was 11.3% and no zinc deficiency was detected. Following supplementation, zinc deficiency was detected in the supplemented groups but not in the control group. The mean serum zinc significantly changed in both supplemented groups while no change was observed in the control group. The reduction in the mean serum zinc was significantly higher in the daily than in the weekly supplemented group. CONCLUSION: Iron supplementation impacts negatively on serum zinc status (exacerbates zinc deficiency) and hence, its contribution to zinc deficiency deserves further investigation especially in the context of the on-going promotion of double fortification strategies that involve iron.

Risk factors for child under-nutrition with a human rights edge in rural villages of North Wollo, Ethiopia.

OBJECTIVE: To identify the factors associated with childhood under-nutrition in North Wollo, Ethiopia. DESIGN: A cross-sectional study. SETTING: Four purposefully selected rural villages (kebeles) in North Wollo zone of the Amhara Region, Ethiopia. SUBJECTS: One hundred-forty four sampled households with under five year old children (n=200) comprising of 96 male-headed, 24 female-headed and 24 landless with children aged between six and 59 months. MAIN OUTCOME MEASURES: Determinations of anthropometric measurements and various socio-economic factors. RESULTS: The overall prevalence rate of under nutrition as determined by stunting, underweight and wasting was 44.5%, 25.0% and 9.0% respectively with more preponderance among the toddlers. The proportion of under nutrition was higher in female-headed households. Shortage of farmland, lack of irrigation, dispossession of livestock, shortage of non-farm employment options, parental illiteracy, high number of children, water inadequacy, food taboos and wrong eating habits of families, poor child feeding practices, deprivation of health nutrition education as well as maternal attributes such as young motherhood, low body mass index and short stature of mothers influenced the nutritional status of the children. The prominent risk factors for undernutrition among children were dispossession of livestock, child food taboos and wrong eating habits of families, deprivation of health/nutrition education, short stature and early marriage of mothers. CONCLUSION: This study led to the conclusion that improvement of household resources through promotion of irrigation and initiation of income generating livelihood options can reverse the nutrition situation for better. Health and nutrition education focusing on appropriate child feeding, eradication of harmful traditional practices such as early marriage and inequitable intra-household food distribution, encouragement of family planning and nutrition interventions including food diversification is recommended.

Malnutrition and iron deficiency in lactating women in urban slum communities from Addis Ababa, Ethiopia.

OBJECTIVE: To determine the status of iron deficiency anaemia (IDA) and malnutrition in lactating women. DESIGN: A cross-sectional study. SETTING: Six urban slum communities in Teklehaimanot district, Addis Ababa. SUBJECTS: One thousand and seventeen lactating women were enrolled and assessed for their haemoglobin (Hgb), serum ferritin level and body mass index (BMI) during the month of March 2001. Iron deficiency anaemia was considered when Hgb and serum ferritin concentrations were less than 12gm/dl and 12 microg/l respectively, whereas, a BMI less than 18.5% kg/m2 was considered malnourished. MAIN OUTCOME MEASURES: Determinations of haemoglobin, serum ferritin and BMI measurements. RESULTS: The overall prevalence of iron deficiency anaemia (IDA) and protein energy malnutrition in the slum communities was 22.3% and 27.1% respectively. The mean age of mothers (28.4 +/- 6.12 years) indicates that prevalence of malnutrition and iron deficiency anaemia was higher among younger mothers than among older mothers. The prevalence of malnutrition was positively correlated with the serum ferritin concentration status, of the mothers (r=0.12, p=0.2, RR=1.03). CONCLUSION: It is observed that malnutrition and IDA are major health problems and therefore, an appropriate nutrition intervention package to improve the nutrition situation of the communities is recommended.

Daily versus weekly iron supplementation and prevention of iron deficiency anaemia in lactating women.

OBJECTIVE: To demonstrate the effectiveness and social feasibility of weekly versus daily iron supplementation in preventing and treating iron deficiency anaemia among anaemic mothers. DESIGN: A longitudinal in nature. SETTING: Seven urban slum communities in Teklehaimanot Wereda, Addis Ababa, Ethiopia. SUBJECTS: Two hundred seven eligible mothers were assigned to the daily supplementation, weekly supplementation or control groups following randomisation between March and May 2001. The daily supplemented groups (n=71) received 60 mg of elemental iron containing 300 mg ferrous sulphate and 400 microg folic acid from Monday to Friday. The weekly group (n=68) received one tablet once a week every Monday supervised while the control group (n=68) was advised to take no medications without the knowledge of the investigators until the completion of the study. To eliminate a major source of variation, subjects participating in the study were de-wormed at the beginning of the study. MAIN OUTCOME MEASURES: Haemoglobin and serum ferritin concentrations were compared before and after the intervention among the groups. RESULTS: The mean haemoglobin (Hgb), and serum ferritin concentration (SFC) at baseline were practically similar among the groups. Haemoglobin levels significantly increased at the end of the study in all the groups and the proportion of anaemia decreased from 6.9% to 1.6% in the daily, 6.7% to 1.7% in the weekly supplemented and 6.7% to 6.1% in the control groups. The difference noted between the daily and weekly supplemented groups was not significant. The improvement of SFC concentration was better in the daily than the weekly group but not statistically significant. Daily supplementation schedule caused more side effects and lower compliance level than the weekly supplementation schedule. CONCLUSION: Weekly supplementation is simple, comparable to daily supplementation and economically advantageous. Thus, it is recommended to adopt the strategy for controlling anaemia. Further because of higher compliance rate and lower side effects, it is deemed to be socially feasible.

Vitamin A supplementation on child morbidity.

OBJECTIVE: To determine the impact of vitamin A supplementation on child morbidity and nutritional status. DESIGN: A community based follow-up (interventional) in nature. SETTING: Two randomly selected Weredas (districts) of Tigray, North Ethiopia were studied between 1996 and 1997. SUBJECTS: Four thousand seven hundred and seventy children aged between six and 72 months, selected using a multi-stage sampling procedure were enrolled and clinically assessed for xerophthalmia and nutritional status. A sub-sample of these children (n = 281) was further assessed for their serum retinol levels. MAIN OUTCOME MEASURES: The pre and post intervention data on xerophthalmia, morbidity, nutritional status and serum retinol levels were compared. RESULTS: Vitamin A capsule coverage of 87% in all the villages of the Weredas and a statistically significant (p < 0.05) reduction in the prevalence of Bitot's spot (from 1.5 to 0.5), fever (from 29.8 to 14.2), diarrhoea (from 30.2 to 18.2), oedema (from 9.2 to 3.2), measles (from 14.0 to 6.2), conjunctivitis (from 10.2 to 3.0), stunted (from 64.2 to 42.7), wasted (from 12.8 to 2.5) and underweight (from 46.2 to 24.2). The proportion of children with normal serum retinol concentration (> 0.7 micromole/L) has also improved significantly (from 36.8 to 56.2). CONCLUSION: In conclusion, the significant improvement in morbidity and nutritional status that followed the intervention programme although encouraging, it still indicates the importance of coupling periodic provision of Vitamin A capsules with nutrition education.

Somatostatin receptor-specific analogs: effects on cell proliferation and growth hormone secretion in human somatotroph tumors.

Somatostatin (SST) acts through a family of seven transmembrane domain G protein-coupled receptors to inhibit hormone secretion and cell proliferation in a variety of neuroendocrine tissues. In normal and neoplastic human pituitary somatotroph cells, SST-specific receptor types (SSTR) 1, 2, 3, and 5 are prevalently expressed, and SST and its analogs have been shown to inhibit GH secretion. However, in somatotroph adenomas, little is known regarding: 1) effects of SST and its analogs on pituitary tumor proliferation; 2) the relationship between the effects of SST analogs on GH secretion and tumor cell proliferation; and 3) whether SSTR expression predicts the antiproliferative effects of SST analogs in human somatotroph tumors. We investigated the effects of SST-14, lanreotide, and SSTR 2 (BIM-23190) and SSTR 5 (BIM-23268) specific analogs in 18 somatotroph pituitary adenomas in primary culture. Our results showed that cell proliferation was significantly inhibited by SST-14, lanreotide, BIM-23190, and BIM-23268 in 4, 7, 3, and 4 tumors, respectively (range of proliferation suppression 5-60%; median, 16%). Tumors that were responsive to SSTR 2- and 5-specific analogs were also responsive to lanreotide. SST-14 inhibited GH secretion in 8 of 13 tumors; lanreotide, BIM-23190, and BIM-23268 inhibited GH secretion in six tumors each (range of GH secretion inhibition 23-43%; median 33%). SSTR 2 and 5 messenger RNA was expressed in all tumors investigated, whereas SSTR 1 and 3 messenger RNA was expressed in 11 and 12 tumors, respectively. We observed a dissociation between the in vitro effects of SST-14 or lanreotide on tumor cell proliferation and the effects on GH secretion in human somatotroph tumors. Although differences in receptor concentration and the presence of other SST receptor subtypes may play a role, the presence of SSTR 2 and/or 5 did not have a predictive value. These data suggest that inhibition of cell proliferation occurs independently of effects on GH secretory pathways. Further studies are needed to clarify the mechanism of SST induced antiproliferative effects.

Interferon alpha is an effective therapy for congenital dyserythropoietic anaemia type I.

The efficacy of interferon-alpha (IFN) was reported in three patients with congenital dyserythropoietic anaemia (CDA) type I. We describe two additional cases treated with IFN, which normalized the haemoglobin level in both patients with a dramatic decrease in the size of the spleen in one. Haemoglobin remained stable more than 6 months after discontinuation of treatment. IFN induced more than 50% decrease in the number of BFU-E in both patients' bone marrow cultures, suggesting an indirect effect of IFN on erythropoiesis in vivo. We conclude that a trial of IFN therapy should be considered in patients with CDA type I.

Zinc supplementation and stunted infants in Ethiopia: a randomised controlled trial.

BACKGROUND: Stunting is highly prevalent in Ethiopia and many other developing countries but the reason for it is poorly understood. Zinc is essential for growth but diets in such countries often do not contain zinc in sufficient quantity or of sufficient bioavailability. Thus zinc deficiency may play a major role in stunting. The aim of the study was to investigate whether the low rate of linear growth of apparently healthy breastfed infants in a rural village in Ethiopia could be improved by zinc supplementation. METHODS: A randomised, double-blind, placebo-controlled trial was done on apparently healthy breastfed infants aged 6-12 months. 100 non-stunted (length-for-age, Z score < -2) were matched for age and sex with 100 randomly selected stunted (> -2) infants. Infants, both stunted and non stunted, were matched by sex, age (within 2 months) and recumbent length (within 3 cm) for random assignment, to receive a zinc supplement (10 mg zinc per day, as zinc sulphate) or placebo, 6 days a week for 6 months. Anthropometric measurements were taken monthly, data on illness and appetite were collected daily, and samples of serum and hair were taken at the end of the intervention for the analysis of zinc. FINDINGS: The length of stunted infants increased significantly more (p<0.001) when supplemented with zinc (7.0 cm [SE 1.1]) than with placebo (2.8 cm [0.9]); and the effect was greater (p<0.01) than in non-stunted infants (6.6 [0.9] vs 5.0 [0.8] cm for the zinc and placebo groups respectively, p<0.01). Zinc supplementation also increased the weight of stunted children (1.73 [0.39] vs 0.95 [0.39] kg for the corresponding placebo group, p<0.001) and of non-stunted children (1.19 [0.39] vs 1.02 [0.32] kg for the corresponding placebo group, p<0.05). Zinc supplementation resulted in a markedly lower incidence of anorexia and morbidity from cough, diarrhoea, fever, and vomiting in the stunted children. The total number of these conditions per child was 1.56 and 1.11 in the stunted and non-stunted zinc supplemented children versus 3.38 and 1.64 in the stunted and non-stunted placebo-treated children, respectively. At the end of the intervention period, the concentrations of zinc in serum and hair of stunted infants, who had not been supplemented with zinc, were lower than the respective concentrations of zinc in serum and hair of their non-stunted counterparts. INTERPRETATION: Combating zinc deficiency can increase the growth rate of stunted children to that of non-stunted infants in rural Ethiopia. This would appear to be due, at least in part, to reduction in morbidity from infection and increased appetite.