Strategies for Mitigating Vitamin A Deficiency in Mekelle, Ethiopia

The fourth United Nations Millennium Development Goal (MDG) is to reduce worldwide child mortality by two-thirds. In the impoverished African country of Ethiopia, child mortality has declined from 123 per 1,000 in 2004/2005 to 88 per 1,000 in 2011/2012 (World Bank, 2013). Yet the rate remains alarmingly high. Micronutrient deficiencies (including iron, zinc, and vitamin A) are contributing to the worldwide child mortality rate. Vitamin A deficiency is one of the most common micronutrient. Between 250,000 and 500,000 children with vitamin A deficiency become blind each year. Within 12 months of becoming blind, half of these children die (World Health Organization (WHO), n.d.). The WHO supports three types of solutions to eliminate vitamin A deficiency; supplementation, dietary diversification, and food fortification. Worldwide, supplementation is the most common practice for providing micronutrients to communities. However, this practice is successful in mainly urban communities and excludes 45% of children around the world. Supplementation programs alone are not fiscally sustainable (Golden Rice Project, 2012). A study by Mekelle University public health faculty concluded vitamin A capsules are a short-term life saving intervention and a transition towards sustainable food-based interventions is needed. Additionally, an intervention to serve the diets of low-income individuals as well as the urban population is crucial (Kidane, Abegaz, Mulugeta, Singh, 2013). In order to fulfill the practicum requirement for the graduate program in public health, Erika Strehl traveled to Mekelle, Ethiopia in June 2014. The objective of this project was to investigate strategies used for mitigating vitamin A deficiency within the Mekelle community. Specific learning objectives included identifying organizations working toward eliminating vitamin A deficiency, classifying the type of project (supplementation, food fortification, dietary diversification), exploring the current and potential barriers within these projects, identifying the gaps in education and supplementation, and identifying communities not receiving education or supplementation. Supplementation of Vitamin A is provided by the Health Extension Workers (HEW), which is a recent program established by the Ethiopian government. The HEW’s are the primary distributors for vitamin A and iron supplements. Infants receive a vitamin A supplement every six months at the Health Post and it is the responsibility of the mother return every six months. Each year thousands of HEW’s are trained to treat various medical problems such as burns, cuts, maternal health, and malnutrition. Food fortification in Mekelle is in the initial stages of implementation, Ethiopia is one of four countries in Africa without a legal food fortification program (Head, Getachew, 2014). The Ministry of Health has appointed a task force to investigate the use of food fortification and potentially propose a legislation to legalize food fortification. A Fulbright Scholar (Ms. Head) collaborated with the Chemistry department at Mekelle University to create technology for food fortification. Currently, there is a lack of locally available technology to fortify food and what is available is currently imported from other countries, which is accompanied by high import duties and a value added tax (VAT) of 15%. Producing the technology in Ethiopia would alleviate the financial burden of importation. Ms. Head worked with local manufacturers to design and build equipment that would be replicable and cost effective. For the past fourteen years Mums for Mums, a local non-governmental organization, has educated women on the importance of dietary diversification. Mums for Mums assists homeless women to learn income generating and life skills to become self-reliant. Food preparation training is accompanied by nutrition demonstrations, which focuses on locally available and highly nutritional food, such as the sweet potato. One cup of the boiled sweet potato everyday satisfies the requirement for vitamin A. Women are instructed how to incorporate the sweet potato into meals to provide a balanced diet for their families. The sweet potato is widely available in Ethiopia and not expensive (Asmelash, personal communication, June 2014). Mekelle currently satisfies the three suggested strategies from the WHO, yet these programs work in isolation from each other. There is a lack of communication and information sharing between the aforementioned programs. With a heavy reliance on supplementation, a shift towards preventive strategies such as nutrition education is a crucial element needed to decrease the prevalence of vitamin a deficiency

ETV6 mutations in early immature human T cell leukemias

A substantial proportion of adult T-ALL samples display gene expression and mutation characteristics of both T cell and acute myeloid leukemias; mutations in ETV6 are found exclusively within this new molecular subgroup of adult T-ALL patients

Furazolidone-based triple therapy for H pylori gastritis in children

AIM: To evaluate the furazolidone-based triple therapy in children with symptomatic H pylori gastritis.METHODS: A prospective and consecutive open trial was carried out. The study included 38 patients with upper digestive symptoms sufficiently severe to warrant endoscopic investigation. H pylori status was defined based both on histology and on positive C-13-urea breath test. Drug regimen was a seven-day course of omeprazole, clarithromycin and furazolidone (100 mg, 200 mg if over 30 kg) twice daily. Eradication of H pylori was assessed two months after treatment by histology and C-13-urea breath test. Further clinical evaluation was performed 7 cl, 2 and 6 mo after the treatment.RESULTS: Thirty-eight patients (24 females, 14 males) were included. Their age ranged from 4 to 17.8 (mean 10.9 +/- 3.7) years. On intent-to-treat analysis (n = 38), the eradication rate of H pylori was 73.7% (95% CI, 65.2%-82%) whereas in per-protocol analysis (n = 33) it was 84.8% (95% CI,. 78.5%-91%)., All the patients with duodenal ulcer (n = 7) were successfully treated (100% vs 56.2% with antral nodularity). Side effects were reported in 26 patients (68.4%), mainly vomiting (14/26) and abdominal pain (n = 13). Successfully treated dyspeptic patients showed improvement in 78.9% of H pylori-negative patients after six months and in 50% of H pylori-positive patients after six months of treatment.CONCLUSION: Triple therapy with furazolidone achieves moderate efficacy in H pylori treatment. The eradication rate seems to be higher in patients with duodenal ulcer. (C) 2006 The WJG Press. All rights reserved.Univ Fed Sao Paulo, Escola Paulista Med, Dept Pediat,Pediat Gastroenterol Div, Pept Dis Outpatient Clin, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Pathol, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Pediat,Pediat Gastroenterol Div, Pept Dis Outpatient Clin, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Pathol, Sao Paulo, BrazilWeb of Scienc

Clinical Factors and Outcomes When Real-World Heart Teams Overruled STS Risk Scores in TAVR Cases.

Objectives: This study was conducted to determine why heart teams recommended transcatheter aortic valve replacement (TAVR) versus surgical AVR (SAVR) for patients at low predicted risk of mortality (PROM) and describe outcomes of these cases. Background: Historically, referral to TAVR was based predominately on the Society of Thoracic Surgeons (STS) risk model\u27s PROM \u3e3%. In selected cases, heart teams had latitude to overrule these scores. The clinical reasons and outcomes for these cases are unclear. Methods: Retrospective data were gathered for all TAVR and SAVR cases conducted by 9 hospitals between 2013 and 2017. Results: Cases included TAVR patients with STS PROM \u3e3% ( Conclusions: Heart teams recommended TAVR in patients with STS PROM ≤3% primarily due to frailty, hostile chest, severe lung disease, and/or morbid obesity. Similar postoperative outcomes between these patients and those with STS PROM \u3e3% suggest that decisions to overrule STS PROM ≤3% were merited and may have reduced SAVR 30-day mortality rate