Lathyrism in rural northwestern Ethiopia: a highly prevalent neurotoxic disorder.

Lathyrism is a disorder of the central motor system, induced by heavy consumption of the grass-pea, Lathyrus sativus an environmentally tolerant legume containing the neurotoxic excitatory amino acid beta-N-oxalylamino-L-alanine (BOAA). A complete door-to-door resurvey of the Dembia and Fogera regions of northwestern Ethiopia, areas endemic for lathyrism, revealed an estimated mean disease prevalence of 0.6%-2.9%. Most patients developed the disease in the epidemic of 1976/77, although new cases appear to have occurred with an estimated mean annual incidence of 1.7:10,000. Production and consumption of grass-pea is increasing in Ethiopia, making attempts to develop low-BOAA strains to prevent lathyrism increasingly important.

Nutrient costing.

For the purpose of computing changes in food cost over time as well as the planning of proper nutrition education and dietary counselling, the cost of important Ethiopian foods was collected in Addis Ababa markets for three and one-half years and computed for the amount of energy and protein yield per unit price. In general, cereals and legumes faired well in their contribution of these nutrients at low cost. Certain foods, such as vetch, sugar and marmalades were also found to contribute a significant amount of nutrients at low cost. Because of the neurotoxic content in vetch and the contribution of a single nutrient as an energy source in the case of the latter two, their utilization during meal planning is subject to careful consideration. Foods of animal origin are second to last in their nutrient contribution per cost although their nutrient density makes them important in consumer demand. Root crops and vegetables that are known for their bulk are at the bottom of the list of good nutrient contributors per cost.

The epidemiology of lathyrism in north and central Ethiopia.

Lathyrism is a neurotoxic disorder caused by excessive, prolonged consumption of the hardy, environmentally tolerant legume, the grass-pea, Lathyrus sativus, which contains the neurotoxic amino acid beta-N-oxalylamino-L-alanine acid (BOAA). The disease develops after heavy consumption of grass-pea for over two months. It is uniformly manifested by a predominantly motor spastic paraparesis with varying degrees of disability. A door-to-door epidemiological survey for the disease using trained lay health workers was carried out in the major areas of northwest and central Ethiopia where L. sativus is grown. For security reasons, some of the other endemic areas wre not accessible for the survey. The survey involved a population of 1,011,272. A total of 3,026 affected persons were identified. The disease was found to be widespread in the northwest and central highland areas of the country. The prevalence rates ranged from 1/10,000 to 7.5/1,000. The highest prevalences were in North and South Gonder, and East and West Gojam. The male:female ratio of cases was 2.6:1; the females exhibited a milder form of the disease. The cultivation of L. sativus is increasing in Ethiopia, which makes the development of low-BOAA strains very important in order to control the high incidence of lathyrism, a crippling disease which affects the productive young members of the society.

Rarity of anaemia of pregnancy in Ethiopia.

Hb and PCV values were studied in three groups of Addis Ababa women during their last month of pregnancy and compared with those in a control group of non-pregnant Addis Ababa women. Irrespective of socio-economic group and parity, the Hb and PCV values were almost identical in all four groups. In one of the three test groups, a group of 'non-privileged' multiparae, S-iron, S-transferrin (TIBC), S-folate and S-vitamin B12 were also examined and showed normal values. These findings indicate a rarity not only of true anaemia but also of 'physiological anaemia of pregnancy'. This latter may not, therefore, be an adaptive phenomenon of regular occurrence as has usually been assumed hitherto. The explanation for the aberrant haematological behavior in pregnant women living in highland Ethiopia is probably the lifelong exposure to a very high iron intake combined with hypoxia due to the high altitude.