HEALTH IN ETHIOPIA: A SUMMARY OF 52 DISTRICT HEALTH PROFILES

ABSTRACT: This paper integrates the data contained in 52 district health profiles completed during the years 1988 to 1991. These profiles encompass approximately 40% of the Ethiopian population and thus provide a summary assessment of health services and health status. Thirty percent of children were found to be attending school, 33% of children under five years of age were malnourished, and 35% of the population had access to safe water. The analysis was stratified by districts, urban versus rural populations, and hospital versus non hospital health institutions. Large disparities between districts were found in measures of health and human development. On a per capita basis, urban districts benefit from three times the number of physicians, four times more nurses, and double the number of health assistants. Nearly 70% of physicians and nurses were hospital based. Of the 1.88 birr per capita yearly health expenditure, hospital budgets accounted for 60%. This summary review of health profiles provides baseline data on the health of Ethiopians early in the establishment of district health services from which future trends can be monitored. [Ethiop. I. Health Dev. 1994;8(2):87-96

Nonlinear Outcome of Gravitational Instability in Disks with Realistic Cooling

We consider the nonlinear outcome of gravitational instability in optically thick disks with a realistic cooling function. We use a numerical model that is local, razor-thin, and unmagnetized. External illumination is ignored. Cooling is calculated from a one-zone model using analytic fits to low temperature Rosseland mean opacities. The model has two parameters: the initial surface density Sigma_0 and the rotation frequency Omega. We survey the parameter space and find: (1) The disk fragments when t_c,eff Omega = 1, where t_c,eff is an effective cooling time defined as the average internal energy of the model divided by the average cooling rate. This is consistent with earlier results that used a simplified cooling function. (2) The initial cooling time t_c0 or a uniform disk with Q = 1 can differ by orders of magnitude from t_c,eff in the nonlinear outcome. The difference is caused by sharp variations in the opacity with temperature. The condition t_c0 Omega = 1 therefore does not necessarily indicate where fragmentation will occur. (3) The largest difference between t_c,eff and t_c0 is near the opacity gap, where dust is absent and hydrogen is largely molecular. (4) In the limit of strong illumination the disk is isothermal; we find that an isothermal version of our model fragments for Q < 1.4. Finally, we discuss some physical processes not included in our model, and find that most are likely to make disks more susceptible to fragmentation. We conclude that disks with t_c,eff Omega < 1 do not exist.Comment: 30 pages, 12 figure

The Nature of the Dense Core Population in the Pipe Nebula: Thermal Cores Under Pressure

In this paper we present the results of a systematic investigation of an entire population of starless dust cores within a single molecular cloud. Analysis of extinction data shows the cores to be dense objects characterized by a narrow range of density. Analysis of C18O and NH3 molecular-line observations reveals very narrow lines. The non-thermal velocity dispersions measured in both these tracers are found to be subsonic for the large majority of the cores and show no correlation with core mass (or size). Thermal pressure is thus the dominate source of internal gas pressure and support for most of the core population. The total internal gas pressures of the cores are found to be roughly independent of core mass over the entire range of the core mass function (CMF) indicating that the cores are in pressure equilibrium with an external source of pressure. This external pressure is most likely provided by the weight of the surrounding Pipe cloud within which the cores are embedded. Most of the cores appear to be pressure confined, gravitationally unbound entities whose nature, structure and future evolution are determined by only a few physical factors which include self-gravity, the fundamental processes of thermal physics and the simple requirement of pressure equilibrium with the surrounding environment. The observed core properties likely constitute the initial conditions for star formation in dense gas. The entire core population is found to be characterized by a single critical Bonnor-Ebert mass. This mass coincides with the characteristic mass of the Pipe CMF indicating that most cores formed in the cloud are near critical stability. This suggests that the mass function of cores (and the IMF) has its origin in the physical process of thermal fragmentation in a pressurized medium.Comment: To appear in the Astrophysical Journa

Risks to Early Childhood Health and Development in the Postconflict Transition of Northern Uganda

Research from numerous fields of science has documented the critical importance of nurturing environments in shaping young children's future health and development. We studied the environments of early childhood (birth to 3 years) during postconflict, postdisplacement transition in northern Uganda. The aim was to better understand perceived needs and risks in order to recommend targeted policy and interventions. Methods. Applied ethnography (interview, focus group discussion, case study, observational methods, document review) in 3 sites over 1 year. Results. Transition was a prolonged and deeply challenging phase for families. Young children were exposed to a myriad of risk factors. Participants recognized risks as potential barriers to positive long-term life outcomes for children and society but circumstances generally rendered them unable to make substantive changes. Conclusions. Support structures were inadequate to protect the health and development of children during the transitional period placing infants and young children at risk. Specific policy and practice guidelines are required that focus on protecting hard-to-reach, vulnerable, children during what can be prolonged and extremely difficult periods of transition

Perturbed cholesterol and vesicular trafficking associated with dengue blocking in Wolbachia-infected Aedes aegypti cells

Wolbachia are intracellular maternally inherited bacteria that can spread through insect populations and block virus transmission by mosquitoes, providing an important approach to dengue control. To better understand the mechanisms of virus inhibition, we here perform proteomic quantification of the effects of Wolbachia in Aedes aegypti mosquito cells and midgut. Perturbations are observed in vesicular trafficking, lipid metabolism and in the endoplasmic reticulum that could impact viral entry and replication. Wolbachia-infected cells display a differential cholesterol profile, including elevated levels of esterified cholesterol, that is consistent with perturbed intracellular cholesterol trafficking. Cyclodextrins have been shown to reverse lipid accumulation defects in cells with disrupted cholesterol homeostasis. Treatment of Wolbachia-infected Ae. aegypti cells with 2-hydroxypropyl-β-cyclodextrin restores dengue replication in Wolbachia-carrying cells, suggesting dengue is inhibited in Wolbachia-infected cells by localised cholesterol accumulation. These results demonstrate parallels between the cellular Wolbachia viral inhibition phenotype and lipid storage genetic disorders

Envelope Structure of Starless Core L694-2 Derived from a Near-Infrared Extinction Map

We present a near-infrared extinction study of the dark globule L694-2, a starless core that shows strong evidence for inward motions in molecular line profiles. The J,H, and K band data were taken using the European Southern Observatory New Technology Telescope. The best fit simple spherical power law model has index p=2.6 +/- 0.2, over the 0.036--0.1 pc range in radius sampled in extinction. This power law slope is steeper than the value of p=2 for a singular isothermal sphere, the initial condition of the inside-out model for protostellar collapse. Including an additional extinction component along the line of sight further steepens the inferred profile. Fitting a Bonnor-Ebert sphere results in a super-critical value of the dimensionless radius xi_max=25 +/- 3. The unstable configuration of material may be related to the observed inward motions. The Bonnor-Ebert model matches the shape of the observed profile, but significantly underestimates the amount of extinction (by a factor of ~4). This discrepancy in normalization has also been found for the nearby protostellar core B335 (Harvey et al. 2001). A cylindrical density model with scale height H=0.0164+/- 0.002 pc viewed at a small inclination to the cylinder axis provides an equally good radial profile as a power law model, and reproduces the asymmetry of the core remarkably well. In addition, this model provides a basis for understanding the discrepancy in the normalization of the Bonnor-Ebert model, namely that L694-2 has prolate structure, with the full extent (mass) of the core being missed by assuming symmetry between the profiles in the plane of the sky and along the line-of-sight. If the core is sufficiently magnetized then fragmentation may be avoided, and later evolution might produce a protostar similar to B335.Comment: 38 pages, 7 figures, accepted to Astrophysical Journa

Solar Magnetic Field Signatures in Helioseismic Splitting Coefficients

Normal modes of oscillation of the Sun are useful probes of the solar interior. In this work, we use the even-order splitting coefficients to study the evolution of magnetic fields in the convection zone over solar cycle 23, assuming that the frequency splitting is only due to rotation and a large scale magnetic field. We find that the data are best fit by a combination of a poloidal field and a double-peaked near-surface toroidal field. The toroidal fields are centered at r=0.999R_solar and r=0.996R_solar and are confined to the near-surface layers. The poloidal field is a dipole field. The peak strength of the poloidal field is 124 +/- 17G. The toroidal field peaks at 380 +/- 30G and 1.4 +/- 0.2kG for the shallower and deeper fields respectively. The field strengths are highly correlated with surface activity. The toroidal field strength shows a hysteresis-like effect when compared to the global 10.7 cm radio flux. The poloidal field strength shows evidence of saturation at high activity.Comment: 10 pages, accepted for publication in Ap

The eclipsing X-ray pulsar X-7 in M33

Using our extensive ROSAT X-ray observations of M33, we confirm a 3.45 day eclipse period for the Einstein source X-7 (Larson & Schulman, 1997) and discover evidence for a 0.31-s pulse period. The orbital period, pulse period and observed X-ray luminosity are remarkably similar to SMC X-1. We therefore suggest M33 X-7 is a neutron star high mass X-ray binary with a 15-40 Msol O/B companion and a binary separation of 25-33 Rsol if the companion is almost filling its Roche lobe.Comment: accepted for publication in MNRA

Selecting candidate predictor variables for the modelling of post-discharge mortality from sepsis: a protocol development project

Background: Post-discharge mortality is a frequent but poorly recognized contributor to child mortality in resource limited countries. The identification of children at high risk for post-discharge mortality is a critically important first step in addressing this problem.Objectives: The objective of this project was to determine the variables most likely to be associated with post-discharge mortality which are to be included in a prediction modelling study.Methods: A two-round modified Delphi process was completed for the review of a priori selected variables and selection of new variables. Variables were evaluated on relevance according to (1) prediction (2) availability (3) cost and (4) time required for measurement. Participants included experts in a variety of relevant fields.Results: During the first round of the modified Delphi process, 23 experts evaluated 17 variables. Forty further variables were suggested and were reviewed during the second round by 12 experts. During the second round 16 additional variables were evaluated. Thirty unique variables were compiled for use in the prediction modelling study.Conclusion: A systematic approach was utilized to generate an optimal list of candidate predictor variables for the incorporation into a study on prediction of pediatric post-discharge mortality in a resource poor setting.Keywords: Candidate predictor variables, pediatrics, prediction, post-discharge mortality, sepsi

Acceptability of and Adherence to Dispersible Zinc Tablet in the Treatment of Acute Childhood Diarrhoea

Zinc treatment is now recommended by the World Health Organization as part of the routine management of acute childhood diarrhoea. A dispersible zinc tablet formulation was developed taking into account the taste, cost, and feasibility to distribute and store. Only limited information is available on the acceptability of and adherence to dispersible zinc tablet. No study has formally assessed whether the formulation is acceptable to children and if caretakers can adhere to the instructions regarding preparation, dosage, and duration of treatment. This community-based study aimed at determining the acceptability of and adherence to a dispersible zinc tablet formulation in a cohort of children (n=320) aged less than five years. Caretakers of children with acute childhood diarrhoea were prescribed zinc tablet treatment and followed up after 2-3 weeks. The formulation was acceptable to children; 90.1% of 303 caretakers perceived that the tablets were equally or even more acceptable to their children com-pared to other medicines. Ninety-eight percent of the children received the standard dose of one tablet per day, and 55.8% completed the full 10-day course of zinc treatment. Adherence rates did not vary by age or gender of the child. These findings indicate that the tablet formulation is acceptable, but further efforts are required to enhance adherence