Effect of 3 Days of Oral Azithromycin on Young Children With Acute Diarrhea in Low-Resource Settings A Randomized Clinical Trial

Importance: World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth. Objective: To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth. Design, Setting, and Participants: The Antibiotics for Children with Diarrhea (ABCD) trial was a multicountry, randomized, double-blind, clinical trial among 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea. Participants were recruited between July 1, 2017, and July 10, 2019, from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. Each participant was followed up for 180 days. Primary analysis included all randomized participants by intention to treat. Interventions: Enrolled children were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days in addition to standard WHO case management protocols for the management of acute watery diarrhea. Main Outcomes and Measures: Primary outcomes included all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment. Results: A total of 8266 children (4463 boys [54.0%]; mean [SD] age, 11.6 [5.3] months) were randomized. A total of 20 of 4133 children in the azithromycin group (0.5%) and 28 of 4135 children in the placebo group (0.7%) died (relative risk, 0.72; 95% CI, 0.40-1.27). The mean (SD) change in length-for-age z scores 90 days after enrollment was -0.16 (0.59) in the azithromycin group and -0.19 (0.60) in the placebo group (risk difference, 0.03; 95% CI, 0.01-0.06). Overall mortality was much lower than anticipated, and the trial was stopped for futility at the prespecified interim analysis. Conclusions and Relevance: The study did not detect a survival benefit for children from the addition of azithromycin to standard WHO case management of acute watery diarrhea in low-resource settings. There was a small reduction in linear growth faltering in the azithromycin group, although the magnitude of this effect was not likely to be clinically significant. In low-resource settings, expansion of antibiotic use is not warranted. Adherence to current WHO case management protocols for watery diarrhea remains appropriate and should be encouraged. Trial Registration: ClinicalTrials.gov Identifier: NCT03130114.publishedVersionPeer reviewe

Survey of indigenous knowledge on gathering, processing and use of edible wild mushrooms for household food security and income generation in Masasi, Tanzania

A survey was conducted in Masasi town and Ndanda in Masasi District, Tanzania on the importance of indigenous knowledge on gathering edible wild mushrooms (EWM) and its contribution to household food security and income. A total of 333 farmers (255 females, 78 males) with age ranging between 30-50 years were interviewed using pre-tested structured questionnaire. More than 92% of farmers were knowledgeable on EWM.The study indicated that 91% of respondent farmers consumed EWM; more than 89% appreciated EWM as food source; more than 80% purchased EWM; more than 67% regarded EWM gathering as income generating activity and more than 58% of farmers consumed processed EWM. More than 70% of farmers in Masasi town and Ndanda? were foundconsuming EWM that were prepared as relish, or stew, or soup and were eatenwith rice or maize, cassava or sorghum stiff porridges. During wet season, EWM were eaten up to three times per week. More than 89% of farmers processed EWM mainly by sun-drying and stored them in plastic bags or wrapping in the newspapers or in clay pots. Masasi districtcommunity lacked oyster mushroom cultivation technology because no training had been conducted on this new crop. Since EWM was regarded as a household food security, 66% Masasi and Ndanda farmers, respectively were eager to learn oyster mushroom cultivation technology as a new crop.Key words: oyster mushroom, food source, consumption, processin

Physical characteristics and selection criteria of Pare white goats in Kilimanjaro and Manyara districts, Tanzania

Tanzania Journal of Agricultural Sciences (2018) Vol. 17 No. 2, 46-53The study was conducted in semi-arid areas of Kilimanjaro and Manyara districts Tanzania to describe the phenotypic attributes, selection preferences and criteria employed by the Pare White Goats (PWG) keepers. A total of 280 does and 140 bucks were measured for live body weight, linear and other morphometric characters. The general linear model (GLM) procedure (SAS, 2002) was used to analyse metric and scored parameters. The bucks were significantly (P<0.001) heavier (33.2±0.5kg) than does (30.4 ± 0.2kg). The heart girth, body length, wither height and rump height were 72.5±0.2, 64.4±0.2, 64.3±0.2 and 64.3±0.2 for females and 75.0±0.4, 66.1±0.4, 67.2±0.3, 67.0±0.3cm for males. Furthermore, the result showed that PWG are predominantly white, with long legs. The percentage of goats with wattles, beards and horns were 33.1, 38.1 and 84.5% respectively. Most of the goats (81.0%) had their ears held horizontally, while 82.4% had straight face and 76.2% of the goats had straight short hairs. Farmers do prefer the PWG because of their ability to deposit fats and high adaptability to semi- arid areas. Thus, the strain can be exploited through selective breeding for hot tropical environments