Dietary practices and xenophthalmia in under-fives in Jimma town, Southwest Ethiopia

Objectives: To assess parent’s knowledge about children’s need for plant sources of vitamin A; to determine the dietary practice with regard to vitamin A intake; to estimate the prevalence of xerophthalmia and; to forward appropriate recommendations.Design: A cross-sectional study.Setting: The study was conducted in Jimma town, southwest Ethiopia, with a total population of about 88,867 from February to April 1995.Participants: Eight hundred and thirty one randomly selected children between the ages of six and 59 months formed the study population.Main outcome measures: The dietary intake of cheap and easily available vitamin A rich foods is assessed and prevalence of xerophthalmlia determined.Results: Only eighty per cent of the children were getting green vegetables, fruits or carrots once weekly or more. The major reasons given for not including vegetables, fruits and carrots in the diet were “cannot afford” (39%), “not available” (33%), and “child too young” (16%). Out of 628 children examined, four (0.6%) were found to have xerophthalmia; three (0.48%) classified as XlB and one (0.16%) as X2.Conclusion: The dietary intake of plant sources of vitamin A in the studied community is far from adequate. Moreover, vitamin A deficiency is found to be a significant public health problem in young children in Jimma town. Periodic vitamin A supplementation, preferablycombined with immunisation, should be a priority action, and parents need to be educated about vitamin A deficiency and its prevention

Calcium deficiency and causation of rickets in Ethiopian children

Objective: To assess the role of calcium in the development of clinical rickets among Ethiopian children coming to Jimma Specialised Hospital outpatient, department. Design: Case control study. Settings: Jimma Specialised Teaching Hospital and surrounding urban and rural community in the catchment area. Subjects: One hundred and thirty five under five year old children (30 cases of rickets and 104 non-rachitic cases) who came for paediatric service in Jimma hospital. Results: The mean (±SD) level of calcium intake for cases and controls was 664.5 (± 102.7) mg and 645.8(± 144.4) mg, respectively. There was no statistically significance difference between the two groups in the mean level of calcium intake (t=0.659, P>0.05). Generally, in both cases and controls the majority of the study participants were taking calcium below the recommended daily calcium requirement of 800 mg for age group according to Food and Nutrition Board of the National Research Council. When adjusted for different co-variates including age, sex, breast feeding history, history of diarrhoea lasting longer than 14 days and 24 hours calcium intake children and religion, occupation, educational status and residence the mothers/care givers using logistic regression model, frequency of exposure to sunlight ( OR=1.55, 95%CI: 1.2, 2.0), being from rural areas(OR= 5.0, 95% CI: 1.1, 23.3) and age 12-23 months (OR= 4.5, 95%CI: 1.2, 16.5) were significantly associated with rickets(

Seed quality and mycoflora associated with chickpea (Cicer arientinum L.) seed in Ethiopia

The study was conducted at Ethiopian Institute of Agricultural Research, Haramaya University and Jimma University, Ethiopia. Crop yield is directly associated with the physical and biological quality of planting material or seed. Ninety-nine (99) chickpea seed lot samples were collected for physical purity, seed health and germination tests from major chickpea growing areas in Ethiopia in the 2016/17 cropping season to assess the status of chickpea seed health and quality among subsistence farmers, research stations and seed growers. The seed lots were grouped as researcher saved, farmers saved and seed growers’ saved seed. The maximum physical purity of 97.5% was recorded for the researcher saved seed lots, 90.8% for the seed growers and 87.4 % for the farmers saved seeds. Foreign matters and broken seeds were the most contaminants found in the seed lots. The seed germination percentages were in the range of 96.3% to 98.5% for all seed sources and there were no significant differences among the seed lot samples. A total of seventeen (17) fungi species were isolated from all seed sources with different frequency and amount. These are Fusarium spp., Aspergillus sp., A. niger, A. flavus, A. nidulans, A. candidus, A. fumigatus, Penicillium sp., Rhizopus sp., Verticillium sp., Rhizoctonia sp., Pythium sp., Alternaria sp., Helminthosporium sp. Phylostica sp., Cladosporium sp., Negrospora sp. Aspergillus flavus was found the most dominant  with recovery (Relative Density=21.53%, Infection rate=10.36%, and Infection Frequency=25.59 %) from all seed lots. There were high variations in relative density, Infection rate, and Infection frequency among isolated fungi. Ascochyta rabiei the most important  chickpea disease was not found in this study. This might relate to the incidence and prevalence of sample collection season/cropping year which was low in expected areas. The current study concluded that there are seed qualities and seed health management issues with regards to different seed sources (farmers, research and private sectors); this entails strong seed quality control and growers’ awareness creation on storage sanitation, seed health test before sowing, and production of healthy crops. To keep the seed health in a better condition, seed growers should keep a wider interval of rotation, develop use of the healthy improved seed, after some  generation (4-5), seed grading to avoid loss of physical purity, use of appropriate storage container (ventilated and clean), seed dressing with safe pesticides, and appropriate moisture level for storage (about 14%) should have to keep. Longer storage also gives a chance to contaminate the whole seed and can expose to decay. Key words: Chickpea, fungi, germination, mycoflora, purity, seed health, seed source

Maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Uterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for this systematic review and meta-analysis. We systematically used PubMed, Cochrane Library, and African Journals online databases for searching. The Newcastle- Ottawa quality assessment scale was used for critical appraisal. Egger's test and I2 statistic used to assess the check for publication bias and heterogeneity. The random-effect model was used to estimate the pooled prevalence and odds ratios with 95% confidence interval (CI). RESULTS: The pooled maternal mortality and morbidity due to uterine rupture in Ethiopia was 7.75% (95% CI: 4.14, 11.36) and 37.1% (95% CI: 8.44, 65.8), respectively. The highest maternal mortality occurred in Southern region (8.91%) and shock was the commonest maternal morbidity (24.43%) due to uterine rupture. The pooled perinatal death associated with uterine rupture was 86.1% (95% CI: 83.4, 89.9). The highest prevalence of perinatal death was observed in Amhara region (91.36%) and the lowest occurred in Tigray region (78.25%). Prolonged duration of operation was a significant predictor of maternal morbidity (OR = 1.39; 95% CI: 1.06, 1.81). CONCLUSIONS: The percentage of maternal and perinatal deaths due to uterine rupture was high in Ethiopia. Uterine rupture was associated with maternal morbidity and prolonged duration of the operation was found to be associated with maternal morbidities. Therefore, birth preparedness and complication readiness plan, early referral and improving the duration of operation are recommended to improve maternal and perinatal outcomes of uterine rupture

Targeting drought-tolerant maize varieties in southern Africa: a geospatial crop modeling approach using big data

Maize is a major staple food crop in southern Africa and stress tolerant improved varieties have the potential to increase productivity, enhance livelihoods and reduce food insecurity. This study uses big data in refining the geospatial targeting of new drought-tolerant (DT) maize varieties in Malawi, Mozambique, Zambia, and Zimbabwe. Results indicate that more than 1.0 million hectares (Mha) of maize in the study countries is exposed to a seasonal drought frequency exceeding 20% while an additional 1.6 Mha experience a drought occurrence of 10–20%. Spatial modeling indicates that new DT varieties could give a yield advantage of 5–40% over the commercial check variety across drought environments while crop management and input costs are kept equal. Results indicate a huge potential for DT maize seed production and marketing in the study countries. The study demonstrates how big data and analytical tools enhance the targeting and uptake of new agricultural technologies for boosting rural livelihoods, agribusiness development and food security in developing countries

Effect of a self-care educational intervention to improve self-care adherence among patients with chronic heart failure: a clustered randomized controlled trial in Northwest Ethiopia

Background: As the burden of cardiovascular disease increases in sub-Saharan Africa, there is a growing need for low-cost interventions to mitigate its impact. Providing self-care health education to patients with chronic heart failure (CHF) is recommended as an intervention to prevent complications, improve quality of life, and reduce financial burdens on fragile health systems. However, little is known about health education’s effectiveness at improving CHF self-management adherence in sub-Saharan Africa. Therefore the present study aimed to assess the effectiveness of an educational intervention to improve self-care adherence among patients with CHF at Debre Markos and Felege Hiwot Referral Hospitals in Northwest Ethiopia. Methods: To address this gap, we adapted a health education intervention based on social cognitive theory comprising of intensive four-day training and, one-day follow-up sessions offered every four months. Patients also received illustrated educational leaflets. We then conducted a clustered randomized control trial of the intervention with 186 randomly-selected patients at Debre Markos and Felege Hiwot referral hospitals. We collected self-reported data on self-care behavior before each educational session. We analyzed these data using a generalized estimating equations model to identify health education's effect on a validated 8-item self-care adherence scale. Results: Self-care adherence scores were balanced at baseline. After the intervention, patients in the intervention group (n = 88) had higher adherence scores than those in the control group (n = 98). This difference was statistically significant (β = 4.15, p < 0.05) and increased with each round of education. Other factors significantly associated with adherence scores were being single (β = − 0.25, p < 0.05), taking aspirin (β = 0.76, p < 0.05), and having a history of hospitalization (β = 0.91, p < 0.05). Conclusions: We find that self-care education significantly improved self-care adherence scores among CHF patients. This suggests that policymakers should consider incorporating self-care education into CHF management

The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study

BACKGROUND: Malnutrition in children can be a consequence of unfavourable socioeconomic conditions. However, some families maintain adequate nutritional status in their children despite living in poverty. The aim of this study was to ascertain whether family-related factors are determinants of stunting in young Mexican children living in extreme poverty, and whether these factors differ between rural or urban contexts. METHODS: A case-control study was conducted in one rural and one urban extreme poverty level areas in Mexico. Cases comprised stunted children aged between 6 and 23 months. Controls were well-nourished children. Independent variables were defined in five dimensions: family characteristics; family income; household allocation of resources and family organisation; social networks; and child health care. Information was collected from 108 cases and 139 controls in the rural area and from 198 cases and 211 controls in the urban area. Statistical analysis was carried out separately for each area; unconditional multiple logistic regression analyses were performed to obtain the best explanatory model for stunting. RESULTS: In the rural area, a greater risk of stunting was associated with father's occupation as farmer and the presence of family networks for child care. The greatest protective effect was found in children cared for exclusively by their mothers. In the urban area, risk factors for stunting were father with unstable job, presence of small social networks, low rate of attendance to the Well Child Program activities, breast-feeding longer than six months, and two variables within the family characteristics dimension (longer duration of parents' union and migration from rural to urban area). CONCLUSIONS: This study suggests the influence of the family on the nutritional status of children under two years of age living in extreme poverty areas. Factors associated with stunting were different in rural and urban communities. Therefore, developing and implementing health programs to tackle malnutrition should take into account such differences that are consequence of the social, economic, and cultural contexts in which the family lives

Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis

BACKGROUND: Anaemia is highly prevalent in children of developing countries. It is associated with impaired physical growth and mental development. Palmar pallor is recommended at primary level for diagnosing it, on the basis of few studies. The objective of the study was to systematically assess the accuracy of clinical signs in the diagnosis of anaemia in children. METHODS: A systematic review on the accuracy of clinical signs of anaemia in children. We performed an Internet search in various databases and an additional reference tracking. Studies had to be on performance of clinical signs in the diagnosis of anaemia, using haemoglobin as the gold standard. We calculated pooled diagnostic likelihood ratios (LR's) and odds ratios (DOR's) for each clinical sign at different haemoglobin thresholds. RESULTS: Eleven articles met the inclusion criteria. Most studies were performed in Africa, in children underfive. Chi-square test for proportions and Cochran Q for DOR's and for LR's showed heterogeneity. Type of observer and haemoglobin technique influenced the results. Pooling was done using the random effects model. Pooled DOR at haemoglobin <11 g/dL was 4.3 (95% CI 2.6–7.2) for palmar pallor, 3.7 (2.3–5.9) for conjunctival pallor, and 3.4 (1.8–6.3) for nailbed pallor. DOR's and LR's were slightly better for nailbed pallor at all other haemoglobin thresholds. The accuracy did not vary substantially after excluding outliers. CONCLUSION: This meta-analysis did not document a highly accurate clinical sign of anaemia. In view of poor performance of clinical signs, universal iron supplementation may be an adequate control strategy in high prevalence areas. Further well-designed studies are needed in settings other than Africa. They should assess inter-observer variation, performance of combined clinical signs, phenotypic differences, and different degrees of anaemia

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events