Iron supplementation and malaria infection : results of a randomized controlled field trial

Iron deficiency anaemia is associated with several ill-health effects. Its treatment and/or control with iron preparations in malaria endemic areas has, however, been implicated to increase host susceptibility to malaria infection. Scientific evidence accumulated to date remains equivocal about the presence of this increased susceptibility. The present work was planned to address the existing controversy by assessing the effect of oral iron supplementation on host susceptibility to malaria infection.A randomized, double-blind, placebo-controlled field trial of oral ferrous sulphate supplementation in schoolchildren 5 to 14 years of age was carried out in northwest Ethiopia where transmission of malaria is high. A total of 500 school children, all with mild-to-moderate iron deficiency, were randomly assigned to receive either ferrous sulphate (60 mg elemental iron per day) or a look-alike placebo, over a period of 12 weeks. Follow-up continued for 24 weeks post-randomization.Children who received iron supplementation tended to develop more clinical attacks of malaria than those children who received placebo, although the difference between the groups was not statistically significant, either during the initial 12 week supplementation period (RR = 1.59; 95% CI: 0.92-2.75) or during the 24 weeks of follow-up (RR = 1.45; 95% CI: 0.95-2.20). Similarly, a trend of increased risk of malaria infection (parasitemia) was noted in the iron-supplemented group over the 24 week follow-up period (RR = 1.22; 95% CI: 0.98-1.52). No difference in any other outcome measure (spleen rate, average enlarged spleen index, and parasite density index) was observed between the groups either during the 12 weeks of supplementation or the 24 weeks of follow-up.This study suggests that iron supplementation, in areas where iron deficiency and malaria co-occur, may enhance host susceptibility to malaria infection. Thus, approaches to control or prevent iron deficiency anaemia in malaria endemic areas should be integrated with malaria control activities in order to minimize the unintended effects of malaria infection while providing the greatest benefit

Correlation and Path Coefficient Analysis in Yield and Yield-Related Components of Black Cumin (Nigella Sativa L.) Accessions, at Jimma, Southwest Ethiopia

Many research works have been done on black cumin focusing on its nutritional and medicinal properties. But, there is inadequate information on the association of yield and yield-constituting traits of black cumin to improve its production. Therefore, correlation analysis was made on thirty-six black cumin accessions evaluated at Jimma in simple lattice design during 2016, to quantify the relationship between traits. The result of the analysis showed that seed yield ha−1 had positive and highly significant correlation with number of effective capsules (0.88), secondary branches (0.73), plant height (0.72), total branches (0.71), steam thickness (0.58), primary branches (0.52), tertiary branches (0.52), harvesting index (0.47), and biological yield (0.43). Path coefficient analysis revealed that harvesting index, biological yield, and number of effective capsules exerted high and favorable direct contribution to seed yield at phenotypic level, whereas harvesting index, biological yield, primary and tertiary branches, number of effective capsules, and stem thickness showed positive direct effect at genotypic level. The favorable direct effects of these traits on grain yield indicate that keeping other variables constant, improvement of these traits will increase black cumin yield. Therefore, these traits should be kept in mind in the future breeding program of black cumin

The potential role of the private sector in expanding postabortion care in Addis Ababa, Amhara and Oromia regions of Ethiopia

Background: Unsafe abortion is a major contributor of maternal mortality and morbidity in Ethiopia. High disease burden and underdeveloped infrastructure entail involvement of all partners in responding to health needs in the country. The private sector has apparently not been exploited to the fullest extent so far. Objective: To assess the potential of private facilities in expanding access to postabortion care (PAC). Methods: A cross-sectional study of private health facilities in Addis Ababa, Amhara and Oromia was conducted in 2001-2, using a pretested questionnaire and a checklist. Results: We assessed 88, 31 and 32 facilities in Addis Ababa, Amhara and Oromia, respectively. Treatment was provided by 44%, 52% and 63% of the eligible facilities in Addis Ababa, Amhara and Oromia, respectively. Manual vacuum aspiration (MVA) was used in treating 61% of Addis Ababa patients whereas sharp curettage was used in over 80% of those in Amhara and Oromia. About 80% of women did not get postabortion family planning methods. Patient-provider interaction was generally satisfactory. High-level disinfection (HLD) of non-autoclavable instruments needed improvement. All medium and above clinics have at least one GP and many have nurse/midwives. The vast majority of facilities not giving the service would like to provide comprehensive PAC if staff are trained and equipment made available in the market. Conclusion: Private health facilities can contribute substantially if given the necessary guidance and support with proper monitoring and evaluation. Ethiop.J.Health Dev. 2003;17(3):157-16

Choosing early pregnancy termination methods in Urban Mozambique

Little is known about who chooses medication abortion with misoprostol and why. Women seeking early abortion in 5 public hospitals in Maputo, Mozambique were recruited in 2005 and 2006 to explore decision-making strategies, method preferences and experiences with misoprostol and vacuum aspiration for early abortion. Client screenings (n = 1799), structured clinical surveys (n = 837), in-depth exit interviews (n = 70), and nurse focus groups (n = 2) were conducted. Triangulation of qualitative and quantative data revealed seemingly contradictory findings. Choice of method reflected women's heightened concerns about privacy, pain, quality of home support, HIV infection risk, sexuality, and safety of research participation. Urban Mozambican women are highly motivated to find early pregnancy termination techniques that they deem socially and clinically low-risk. Although 42% found vaginal misoprostol self-administration challenging and 25% delayed care for over a week to amass funds for user fees, almost all (96%) reported adequate preparation and comfort with home management. Women reported satisfaction with all methods and quality of care, even if the initial method failed or pain management or postabortion contraception were not offered. A more nuanced understanding of what women value most can yield service delivery models that are responsive and effective in reducing maternal death and disability from unsafe abortion.Mozambique Abortion Privacy Misoprostol Satisfaction Nurses Decision making Mixed-methods

Choosing early pregnancy termination methods in Urban Mozambique

Little is known about who chooses medication abortion with misoprostol and why. Women seeking early abortion in 5 public hospitals in Maputo, Mozambique were recruited in 2005 and 2006 to explore decision-making strategies, method preferences and experiences with misoprostol and vacuum aspiration for early abortion. Client screenings (n = 1799), structured clinical surveys (n = 837), in-depth exit interviews (n = 70), and nurse focus groups (n = 2) were conducted. Triangulation of qualitative and quantative data revealed seemingly contradictory findings. Choice of method reflected women's heightened concerns about privacy, pain, quality of home support, HIV infection risk, sexuality, and safety of research participation. Urban Mozambican women are highly motivated to find early pregnancy termination techniques that they deem socially and clinically low-risk. Although 42% found vaginal misoprostol self-administration challenging and 25% delayed care for over a week to amass funds for user fees, almost all (96%) reported adequate preparation and comfort with home management. Women reported satisfaction with all methods and quality of care, even if the initial method failed or pain management or postabortion contraception were not offered. A more nuanced understanding of what women value most can yield service delivery models that are responsive and effective in reducing maternal death and disability from unsafe abortion. (C) 2010 Elsevier Ltd. All rights reserve

Clinical diagnosis of completeness of medical abortion by nurses: a reliability study in Mozambique

Background: The provision of medical abortion continues to rely on routine use of ultrasound to confirm expulsion of pregnancy. However, the absence of ultrasound in most of the health facilities in developing countries and the additional training required to enable providers to use ultrasound is often prohibitive. The purpose of this study was to compare clinical history and physical examination with ultrasound in confirming completion of abortion. Study Design: A total of 718 women consented for medical abortion with misoprostol and were assessed for pregnancy expulsion by nurses and gynecologists. Nurses used history and physical examination while gynecologists used ultrasound to establish their diagnoses. Results: Nurses' clinical diagnoses for complete abortion, incomplete abortion and ongoing pregnancy were 83% (SE 0.01), 15% (SE 0.01) and 2% (SE 0.01), respectively. When gynecologists used ultrasound, the diagnoses for complete abortion, incomplete abortion, an ongoing pregnancy were 80% (SE 0.01), 17% (SE 0.01) and 3% (SE 0.01), respectively. Overall, nurses agreed with gynecologist diagnoses in 84% of cases, with a K coefficient of 0.49 (SE 0.06) and chance-corrected first-order agreement (AC(1)) of 0.81 (SE 0.02). Agreement was very high for the diagnosis of complete abortion (AC(1) 0.89; SE 0.02), while it was moderate for ongoing pregnancy (AC(1) 0.58; SE 0.22) and incomplete abortion (AC(1) 0.45; SE 0.08). Conclusions: Clinical history and physical examination alone, without the use of ultrasonography, are effective for the determination of successful pregnancy expulsion. However, greater emphasis is required on the clinical identification of ongoing pregnancy during any training of providers. (C) 2012 Elsevier Inc. All rights reserve