Incidence of neonatal morbidity at Gondar town, Ethiopia.

OBJECTIVE: To determine the incidence and pattern ofneonatal morbidity. DESIGN: For all neonates delivered in the hospital at least one home visit was arranged to collect morbidity data during neonatal period. This collection took place for a period of one year from 1 September 1995 to 31 August 1996. SETTING: Maternity Ward of the Gondar College of Medical Sciences Hospital. PATIENTS: 320 neonates were visited at home and were evaluated for any morbidity. RESULTS: Of the 320 neonates visited at home during the first 24 to 38 days post delivery 83 (25.9%) were found to be sick. URTI (Upper Respiratory Tract Infection), jaundice, pneumonia and neonatal septicimia were diagnosed by physical examination. Non-breastfeeding was associated with neonatal morbidity (p<0.001). CONCLUSIONS: The neonatal morbidity found during the home visit in this study is very high. A concerted effort is needed to improve both antenatal and postnatal care services to prevent neonatal morbidity and to identify sick neonates timely to provide appropriate care in this setting.

Clinical studies in persistent diarrhea: dietary management with green banana or pectin in Bangladeshi children.

BACKGROUND & AIMS: Because of the beneficial intestinal effects of dietary fibers, we have evaluated the therapeutic effects of green banana or pectin in children with persistent diarrhea. METHODS: In a double-blind trial, 62 boys, age 5-12 months, were randomly given a rice-based diet containing either 250 g/L of cooked green banana (n = 22) or 4 g/kg pectin (n = 19) or the rice-diet alone (control, n = 21), providing 54 kcal/dL daily for 7 days. Stool weight and consistency, frequency of vomiting and purging, and duration of illness were measured. RESULTS: Most children (60%) had no pathogens isolated from stools, 17% had rotavirus, 5% Vibrio cholerae, 4% Salmonella group B, and 11% had enterotoxigenic Escherichia coli infections. By day 3 posttreatment, significantly (P < 0.001) more children recovered from diarrhea receiving pectin or banana than controls (59%, 55%, and 15%, respectively). By day 4, these proportions correspondingly increased to 82%, 78%, and 23%, respectively, the study diet groups being significantly (P < 0.001) different than controls. Green banana and pectin significantly (P < 0.05) reduced amounts of stool, oral rehydration solution, intravenous fluid, and numbers of vomiting, and diarrheal duration. CONCLUSIONS: Green banana and pectin are useful in the dietary management of persistent diarrhea in hospitalized children and may also be useful to treat children at home.

Aeromonas-associated diarrhoea in Bangladeshi children: clinical and epidemiological characteristics.

We studied the clinical and epidemiological features associated with Aeromonas diarrhoea by a hospital survey of 7,398 children under 5 years of age presenting with diarrhoea. The data were actually based upon two cohorts from this survey, the majority of the data being identified from 405 (5.5%) in whom Aeromonas was the sole enteric pathogen. Aeromonas caviae was the most prevalent species, accounting for 32% (129/405) of all isolates. Eighty-three per cent of children with Aeromonas-associated diarrhoea were younger than 3 years. The majority of the children had acute onset of vomiting and watery diarrhoea resulting in mild to moderate dehydration. Fever, non-watery diarrhoea, age less than 3 years, and diarrhoea of 7-14 days duration were found to be significantly associated with Aeromonas diarrhoea compared with Vibrio cholerae O1 infection after adjusting for confounders. Aeromonas-associated diarrhoea was most common from March to May (during the peak of the hot and humid season), and September to October, similar to Vibrio cholerae O1. Our results indicate that Aeromonas infection is common in young children presenting with diarrhoea in Bangladesh.

Shigellosis in children: a clinico-epidemiological comparison between Shigella dysenteriae type I and Shigella flexneri.

We reviewed the clinical and epidemiological features of 390 children under 5 years of age infected with either Shigella dysenteriae type I or Shigella flexneri attending a diarrhoea treatment centre from 1993 to 1995 in Dhaka, Bangladesh. Older age (24 months or more), underweight and wasting but not stunting were the host factors significantly more associated with Shigella dysenteriae type I infection than in Shigella flexneri-infected children. Moreover, use of antibiotics at home, use of water from tubewells or pipe-water for drinking and lack of sanitary facilities for defaecation were the behavioural and environmental factors strongly associated with S. dysenteriae type I infection. Children with diarrhoea due to S. flexneri presented with more watery/liquid stools and had a shorter duration of illness. Duration of diarrhoea for 4 or more days was typical of S. dysenteriae type I infection. Interventions to address malnutrition and to promote environmental hygiene would be predicted to offer greater protection against shigellosis due to S. dysenteriae than S. flexneri.

Cryptosporidium infection in children in urban Bangladesh.

We reviewed data during 1991-94 from a systematic 4 per cent subsample of all patients who presented with diarrhoea to our facility, in which there were 1949 cases of acute diarrhoea in children between the ages of birth to 59 months. Cryptosporidia oocysts were detected in the stools of 68 (3.5 per cent) of these children. A case-control study was designed using surveillance data which included the 68 children with stool positive for Cryptosporidium as cases. Two hundred and four children who did not have Cryptosporidium were randomly selected to serve as controls. The most common presentations were watery diarrhoea (91 per cent), dehydration (81 per cent), and vomiting (71 per cent), and Cryptosporidium was detected throughout the year, but was most frequently isolated during April to October. Lowest rates of detection were observed in the months of November, December, and January. Age below 2 years, non-breastfeeding, and stunting were significantly associated with Cryptosporidium infection. In multivariate analysis of our study we found that only stunted (P = 0.031) and non-breastfed children (P = 0.022) had a greater risk of having Cryptosporidium infection.

AIDS related knowledge and behaviours among college students, Gondar, Ethiopia: a comparative study.

AIDS-related knowledge and behaviours among students at the Gondar College of Medical Sciences, Gondar, Ethiopia were evaluated based on identical surveys conducted in 1990 and 1992. One hundred three second year students provided information in 1992. Analysis indicated that 49% were engaged in sexual intercourse and only a third of these group used condom despite their improved knowledge and belief on condom compared to their previous position in 1990 (p < 0.004). On the other hand, their sexual behaviours regarding sexual contact with high risk individuals decreased compared to 1990 (p < 0.0005). Their general level of AIDS-related preventive knowledge increased over time (p < 0.002), although there was no significant difference in knowledge observed among different sexes and departments. Among the sexually active, a large proportion of students (22%) still had sexual contact with high risk individuals and only 33% of them were using safer methods. Continuing efforts, including peer education, specific health education interventions are still crucially needed to bring a positive change in sexual behaviour.

PIP: Results of identical surveys administered to 164 students before their admission (1990 survey) to the Gondar College of Medical Sciences in Ethiopia and the 103 of these students who completed their second year at the school (1992 survey) were compared to investigate trends in AIDS-related knowledge and practices. The proportion of students aware that AIDS can be prevented by condom use increased from 69% in 1990 to 84% in 1992, and the percentage who considered themselves knowledgeable about current methods of AIDS prevention rose from 62% to 80%. In terms of sexual behavior, only 24% of students who were sexually active in 1990 used condoms at most recent sexual intercourse compared with 33% in 1992. The proportion whose most recent sexual partner was from a high-risk group (i.e., prostitutes) decreased from 47% in 1990 to 34% in 1992. These changes occurred in the absence of a sex education or AIDS prevention program at the university. There was no association between AIDS knowledge and condom use in either survey. The gap between Ethiopian students' knowledge of the protective effect of condom use and their actual use of condoms requires an extensive health education campaign, including peer education.

Risk factors for deaths in under-age-five children attending a diarrhoea treatment centre.

Few case-control studies have examined possible risk factors for diarrhoeal deaths in under-age-five children in the developing countries. We analysed data from the surveillance system of our diarrhoea treatment centre/hospital for the period 1990-94 on 928 children less than 5 years of age. In univariate analysis, 11 factors were significantly associated with death: lack of breastfeeding, severe malnutrition, complicated diarrhoea, pneumonia, xerophthalmia, duration of diarrhoea 7-14 days, moderate or severe dehydration, recent history of measles, Shigella flexneri infection, maternal illiteracy, and very low household income. Rotavirus diarrhoea was negatively associated with fatal outcome. In the assessment of severe malnutrition, weight-for-height measurement discriminated mortality risk better than weight-for-age or height-for-age indices. Only two factors retained their significance, severe malnutrition and non-breastfeeding in the multivariate analysis with adjusted odds ratio (95% confidence interval) of 84.2 (9.1, 775.9) and 4.2 (1.3, 13.2) respectively.

Health behaviour of rural mothers to acute respiratory infections in children in Gondar, Ethiopia.

One hundred and thirty two mothers in a rural area were interviewed to determine how they recognize pneumonia and what type of treatment they propose for pneumonia and mild ARI. Most mothers recognized pneumonia by grunting fast breathing and high fever, but only 35.6% of them propose taking these children to the health centre. Health damaging traditional practices particularly for mild ARI are widespread. Information regarding prevailing beliefs and practices in childhood ARI have a policy implication in the formulation of health education strategy for ARI control.

PIP: During November-December 1990 in northwestern Ethiopia, medical students interviewed 132 mothers with at least 1 child younger than 5 years old living in the villages of Dembosge, Koladuba, and Gondar so researchers could assess the mothers' knowledge, attitudes, and practices regarding acute respiratory infections (ARI) in their children. All the mothers were married Christians from the Amhara tribe. 61.4% were illiterate. Most mothers recognized that respiratory rate (77.3%), high fever (76.5%), and decreased feeding (62.8%) were important signs of pneumonia. They all knew that grunting was also an important sign. Only 35.6% would take their child with these symptoms to a nearby health center. Other common treatments were taking the child to a traditional healer (64.4%) and applying butter and herb to the chest via a massage at home (95.5%). Traditional practices were the predominant interventions proposed by the mothers for mild ARI (e.g., cold, sore throat, and ear discharge). Most (58.3%) mothers proposed to clean the ear and to keep it dry. 85.6% of mothers would take their child with a sore throat to a traditional healer for tonsil extraction, a hazardous practice. The only treatment for mild ARI associated with maternal education was tonsil extraction by a traditional healer. Specifically, illiterate mothers were more likely to seek this treatment for their ill child than literate mothers (91% vs. 76%; p = 0.03). Effective ARI health education needs to be based on understanding the prevailing knowledge, beliefs, and practices of the mothers. Thus, the national ARI control program in Ethiopia should consider these findings when developing ARI policy.

Analysis of the use of oral rehydration therapy corner in a teaching hospital in Gondar, Ethiopia.

Children under five years of age attending the Paediatrics Department, Gondar College of Medical Sciences, oral rehydration therapy (ORT) corner for acute diarrhoea in the year 1988-90 are analysed using only eight variables. Of 1003 children, 38.1% presented with no dehydration, 61.3% with some dehydration and 0.6% with severe dehydration. Eighty four percent of the children were below two years of age. Ninety seven per cent of the dehydrated children were managed with oral rehydration solution and only 3% required admission and intravenous therapy. September to October were the peak months of diarrhoeal episodes. Malnourished children had a four fold higher risk of developing dehydration than well nourished children. The diarrhoea pattern and its association with nutritional status, degree of dehydration and outcome are discussed. Establishment of an ORT corner and the wide use of ORS in all health care facilities are recommended.

College students' attitudes and knowledge of AIDS.

To determine attitudes and knowledge of AIDS, a survey was conducted among students at the Gondar College of Medical Sciences, Gondar, Ethiopia. One hundred sixty four new incoming students (115 males, 49 females) in all departments in 1990-91 academic year provided information. The results reveal that 40% of the students have experienced sexual intercourse. Their knowledge of AIDS was adequate and comparable with other college and high school students, but the majority of those who practice sex do not use condoms and a fifth have had a sexual contact with a high risk individual.

PIP: Sero-epidemiological surveys conducted in Ethiopia since 1987 indicate that the prevalence of HIV infection seems to be increasing. This paper reports findings from a survey of knowledge, attitudes, and practices relating to HIV/AIDS among students at the Gondar College of Medical Sciences in Gondar, Ethiopia. 115 male and 49 female incoming students for the 1990-91 academic year were sampled. 49.5% of the boys and 18.3% of the girls had experienced sexual intercourse. 75.8% of the sexually active students, however, did not use condoms and 47% of then had had sexual contact with a casual partner or prostitute. More narrowly, 19.6% of the sexually experienced had had sex with a prostitute and 27.3% had done so with a casual partner. Sampled students engaged in unprotected sex despite having overall adequate knowledge of AIDS which was comparable to that of other college and high school students. 88.4% accepted AIDS as a deadly disease and 61.6% knew the acceptable preventive measures. at 3.1.% did not know or did not agree that condom use can prevent the sexual transmission of HIV.

The prune belly syndrome: triad syndrome.

The prune belly syndrome is described in a 2 month old male infant who presented with abdominal distension since birth to Paediatrics Department, Gonder College of Medical Science Hospital, in November 1991. The clinical and radiological presentations and theories concerning the genesis of the syndrome are briefly discussed with a review of the literature.

Childhood malignancies in an Ethiopian teaching hospital.

A retrospective study for the ten year period 1981 to 1990 was done to determine the pattern of childhood malignant diseases in the Paediatrics Department of the Gonder College of Medical Sciences, Gonder, Ethiopia. The 71 children identified represented 0.66% of the total paediatric admissions. Ages ranged between 4 months and 14 years with the male to female ratio 3.4:1. Lymphoma was the commonest tumour (25.4%) followed by bone and soft tissue sarcomas (19.7%) and retinoblastoma (15.5%). Leukaemia accounted for 11.3% of the cases. The findings are compared with those from other countries.

[Traditional medicine in Ethiopia in childhood diseases]. / Traditionelle Medizin in Athiopien bei Erkrankungen im Kindesalter.

Parents of 100 paediatric patients hospitalized in the Gondar College of Medical Sciences were interviewed on their knowledge of and experience with indigenous medicine in the region. The result has provided an orienting review of methods used for common childhood disorders and attitudes towards traditional and modern medicine, resp. and some understanding of ideas of the rural population on the "etiology" of some diseases. Among the methods some are dangerous. Traditional medicine is the primary (and often the only) source of health care for major parts of the population in developing countries. Some knowledge of this system is also necessary for modern style medical staff working in such regions for a variety of reasons. Some of these aspects are discussed.

PIP: The parents and grandparents of 100 pediatric patients hospitalized at the Hospital of the Gondar college of Medical Sciences were interviewed by means of a questionnaire containing personal data, methods of traditional medicine, treatment of 30 widespread diseases and disorders of children, views about probable causes, the diagnosis of the "local healer", and the effectiveness of his treatment. Most of those interviewed came from the Gondar region, and they had an 82% illiteracy rate. 85 of the 100 children had been treated by traditional medicine: 9 experienced improvement, but the condition of 15 worsened as a result. 68% of respondents thought that traditional medicine was more cautious and conservative, 46% cited easy access to it, and 6% the low cost as the reasons for using it. 62% vowed never to use it, though after their hospital experience, still 36% claimed they would turn to the local healer again. Over 80% had uvulectomy done to treat upper respiratory diseases, and circumcision of boys is almost 100% (it is also frequent among girls). Spirits healers are distinguished from local healers: they are Christian Orthodox clergymen who exorcise demons and ghosts. Amulets, arm rings, hair style, eye makeup is supposed to protect from the evil eye. Certain practices are dangerous: application of parts of a plant causing deep necrosis, Embelia shimperi and Hagenia abyssinia used for deforming can be deadly, phlebotomy for meningitis can cause extreme anemia, the use of red-hot iron to treat infections can not only result in scarification but also sepsis. Malnutrition and kwashiorkor is often neglected, as is tuberculosis when the local healer acts. 34 of the 100 patients had TB, 7 of whom had spondylitis. The improvement of hygiene and programs to educate the populace should be implemented.