COMMUNITY AND FACILITY SURVEYS ILLUMINATE THE PATHWAY TO CHILD SURVIVAL IN LIBEN WOREDA, ETHIOPIA

ABSTRACTObjectives: To apply "Pathway to Survival" analysis to baseline assessments to informintegrated management of childhood illness programmes.Design: A cross-sectional survey evaluating community-based knowledge, practices andcoverage and health facility quality.Setting: Liben Woreda (population 122, 410), a district in Borana Zone, of Ethiopia'sOromia region, from August 1997-Febuary 1998.Subjects: Three hundred and sixty eight mother-child pairs (age <24 months) seen inthe community and 28 children (age<5 years) in health facilities.Results: Of the 368 mothers interviewed 50% reported that their child was ill in theprevious two weeks (184/368). Amongst the 101 mothers of children under the age ofsix months only 24% reported exclusive breast-feeding (24/101). There were 194 childrenwho should have completed their immunisation schedule; only 17% of them had doneso (33/194). Amongst the 111 children who had diarrhoea, only 17% had received hometreatment with ORS (19/111). Thirty per cent of mothers of children with possiblepneumonia (25/83) and 28% who reported malaria (14/50) sought appropriate care.Amongst those caregivers seen at the health facility only 26% had an understandingof treatment recommendations.Conclusions: Based on the pathway to survival analysis, mother's knowledge of illnessrecognition is limited and they practice both home care and care seeking poorly. Thusfew children are likely to receive and comply with standard case management

Improving influenza surveillance in sub-Saharan Africa

PROBLEM: Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations. APPROACH: A project known as Strengthening Influenza Sentinel Surveillance in Africa (SISA) was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance LOCAL SETTING: Influenza surveillance systems in the target countries were in different stages of development when SISA was launched. Senegal, for instance, had conducted virological surveillance for years, whereas Sierra Leone had no surveillance activity at all. RELEVANT CHANGES: Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organized. LESSONS LEARNT: Targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership

Fossil musk turtles (Kinosternidae, Sternotherus

The oldest fossil musk turtles, genus Sternotherus, are reported from the Hemphillian of eastern Tennessee and central Florida. Sternotherus palaeodorus, n. sp., is known from five partial shells discovered at the late Miocene-early Pliocene (7-4.5 Ma; late Hemphillian) Gray Fossil Site in Washington County, Tennessee. Sternotherus palaeodorus possesses an enlarged intergular scute, wide first vertebral scute that overlaps peripheral set 1, posteriorly extensive hypoplastron to peripheral 7 contact, and a posteriorly situated inguinal musk duct pore (characteristics more typically seen in Kinosternon). A cladistic analysis recovered S. palaeodorus within crown group Sternotherus in the strict consensus and on the stem of Sternotherus in the majority rule consensus. Sternotherus bonevalleyensis, n. sp., from the Palmetto Fauna (5.5-5 Ma; late Hemphillian) of central Florida was perhaps contemporaneous with S. palaeodorus and is known only from isolated shell fragments. It is morphologically most similar to the Sternotherus minor complex and Sternotherus depressus. Subsequent Blancan fossils from the Suwannee River of Florida represent aff. S. minor peltifer. Additionally, a fragmentary left hyoplastron of cf. Sternotherus from Haile 19A, Alachua County, Florida, could be the oldest record for the genus (ca. 9-8.5 Ma; early Hemphillian). These accounts reveal that Sternotherus was diverse and moderately well distributed geographically by its first known fossil occurrences and support previous hypotheses that the Sternotherus minor complex evolved in the Gulf coastal plain and dispersed throughout that region since at least the latest Miocene-earliest Pliocene