Efficacy of Cymelarsan and Diminasan against Trypanosoma equiperdum infections in mice and horses.

Trypanocidal sensitivity studies were conducted to assess the efficacy of Diminazene diaceturate (Diminasan) and Bis (aminoethylthio) 4-melaminophenylarsine dihydrochloride (Cymelarsan) against Trypanosoma equiperdum (isolated from two mares with chronic cases of dourine) 713/943 and 834/940 Dodola strains in experimentally infected mice and horses. Diminasan at doses from 3.5 mg/kg to 28 mg/kg and Cymelarsan at doses of 0.25 mg/kg and 0.5 mg/kg body weight failed to cure any of the mice, indicating a clear dose dependent relationship in the mean time of relapse observed in mice. Indeed, mice treated with lower doses relapsed after a shorter time than mice treated with higher doses. However, mice treated with Cymelarsan at doses of 1.0 mg/kg and 2.0 mg/kg body weight were cured and no parasitemia was observed for 60 days. The efficacy of Cymelarsan was also tested in horses. Two groups of horses containing two animals each were infected with T. equiperdum 834/940 Dodola strain and treated with Cymelarsan at a dose rate of 0.25 mg/kg and 0.5 mg/kg, respectively. Cymelarsan at 0.25 mg/kg and 0.5 mg/kg body weight cleared parasitemia within 24 h post treatment and none of the animals were found to show relapse throughout the 320 days of observation. The sensitivity of the particular trypanosome strain to Cymelarsan was also supported by the relative improvement in the mean PCV levels of horses following treatment. A statistically significant difference (p<0.01) in the mean PCV levels of horses treated with Cymelarsan was observed between day 20 at peak parasitemia and days 40 as well as 60 of observation. The mean PCV levels of horses in the control group progressively decreased within the first 60 days of post infection. Two of the horses in the control group developed chronic form of dourine manifested by genital as well as nervous signs with progressive loss of body condition within 320 days post infection. The efficacy of Cymelarsan against the chronic form of dourine was confirmed after treatment of one of the control horses with Cymelarsan at a dose rate of 0.25 mg/kg body weight at day 282 post infection. It was noted that the treated horse improved overall body condition and clinical signs such as incoordination of hind legs, weakness and ventral oedema disappeared within 10 days of treatment. Thus, Cymelarsan was found to be quite effective in curing horses in acute as well as chronic form of dourine. The results obtained from the present study will be important for designing effective control measures against dourine.

Seroepidemiological survey of trypanozoon infection in horses in the suspected dourine-infected Bale highlands of the Oromia region, Ethiopia.

This paper presents the results of a seroepidemiological survey of trypanozoon infection in horses carried out between September 2007 and June 2008. The survey was conducted to determine the seroprevalence of anti-trypanozoon antibodies in 880 serum samples collected randomly from selected horse-breeding districts of the Bale highlands of Ethiopia. The seroprevalence of trypanozoon infection was found to be 173 (19.66%) and 140 (15.91%) for the CATT/T. evansi and LATEX/T. evansi tests, respectively. The high seroprevalence of trypanozoon infection strongly indicates that the infection is endemic. Neither test can differentiate between anti-trypanozoon antibodies caused by infection with T. equiperdum (the causative agent of dourine) and those of T. evansi (the causative agent of surra). The findings of the present study suggest that field-applicable screening serological tests such as the CATT/T. evansi and LATEX/T. evansi could be useful for epidemiological studies and the control of trypanozoon infection.

Experience of stigma and discrimination and the implications for healthcare seeking behavior among people living with HIV/AIDS in resource-limited setting

Background: Stigma and discrimination can limit access to care and treatment services. Stigma hides HIV from the public; resulting in reduced pressure for behavioral change. For effective behavior change; empirically grounded and theory-based behavioral change approaches are fundamental as a prevention interventions directed on decreasing stigma and discrimination. The objective of the study was to assess the experience of stigma and discrimination on the psychosocial and health care seeking behavior of people living with HIV/AIDS (PLHIV) in Arba Minch; Ethiopia. Methods: This study uses qualitative methods involving focus-group discussions and in-depth interviews conducted in Arba Minch town and nearby Kebeles. Our sample consisted of PLHIV and other key informants who were purposively selected. Data were analyzed manually using thematic content analysis framework. Results: It appears that the magnitude of stigma and discrimination in the area has decreased to a considerably lower level; however; the problem's severity is still being influenced by various factors including: current residence; disclosure status and level of community's awareness about HIV/AIDS. Care and support services provided to PLHIV were well accepted by the respondents and the majority of them were willing to make use of any service available. Health information messages that have been disseminated to the public through mass media since the start of the epidemic in 1984 and AIDS cases in 1986 have played a significant role regarding the current prevailing problem of stigma and discrimination of PLHIV. Conclusion: Stigma and discrimination have come to a level that can be tolerated by most PLHIV that live in this region; especially those who have disclosed their HIV status and were living in urban areas. This calls for a strategy that improves the rates of serostatus disclosure after HIV counseling and testing and strengthens and integrates activities in the task of expanding care and support activities

The use of enzyme linked immunosorbent assays to investigate the prevalence of Trypanosoma equiperdum in Ethiopian horses.

A field study involving 309 horses was undertaken in the provinces of Arsi and Bale in the Ethiopian highlands to investigate the prevalence of Trypanosoma equiperdum infections using enzyme linked immunosorbent assays (ELISAs) for the detection of both trypanosomal antigen and antibody. Adult horses of both sexes were examined for clinical signs of T. equiperdum infection and serum samples were collected for the assays. One hundred and one horses showed the presence of trypanosomal antibodies in their serum and 70 animals showed typical clinical signs of dourine. Nineteen horses showed the presence of trypanosomal antigen. Eight horses were positive for both T. equiperdum antibody and antigen. Blood and genital washes from seven antigenaemic horses were inoculated into mice and rabbits in an attempt to isolate trypanosomes but none became infected. Statistical analysis of the results of antibody assays indicated that there were significant differences in the distribution of serologically positive horses in the different clinical groupings, with seropositivity increasing with the severity of the observed clinical signs (P < 0.001). There was also a positive correlation between the presence of circulating trypanosomal antigen and clinical evidence of infection. Although it was not possible to obtain direct parasitological evidence of infection, the results of the serological assays, together with the clinical signs of disease observed in many of the horses, provide strong circumstantial evidence that T. equiperdum occurs in Arsi and Bale provinces of Ethiopia. Furthermore, in view of the large number of horses in Ethiopia and the unrestricted movement of animals throughout the country it is likely that dourine may be more widespread in Ethiopia than is currently realised. The assays used show potential for diagnosis of dourine, but to be widely applied in field situations for the diagnosis and control of dourine in Africa they require validation of their specificity and sensitivity.

Nutritional assessment of two famine prone Ethiopian communities.

STUDY OBJECTIVES: To compare two ethnically distinct Ethiopian populations (Oromo Arsi in Elka in the Rift Valley and Anyuak in Punjido in Gambella) for two widely used anthropometric indices of protein-energy malnutrition: body mass index < 18.5 and arm muscle circumference < 80% of the median of the US NHANES reference data. DESIGN: Anthropometric measurements were made in two cross sectional community surveys. SETTING: The Elka village in the central Rift Valley and the Punjido village in western Ethiopia. PARTICIPANTS: 1170 and 560 people from all age groups in Elka and Punjido, respectively. MAIN RESULTS: Estimates of the prevalence of malnutrition in each group differed considerably when defined from the body mass index, but were quite similar when the arm muscle circumference was used. Data for children indicated that the boys and girls in one group (Punjido) were taller but had about the same weights for age as those in the other group (Elka), suggesting that the low body mass indices among the Punjido might have a genetic basis. CONCLUSIONS: Body mass index systematically overestimates the prevalence of malnutrition among the Anyuaks in Punjido. Local reference data from a well nourished Anyuak sample or from an ethnically related population is needed to evaluate appropriately malnutrition using the body mass index. This study shows that care must be taken when assessing different ethnic groups using existing international anthropometric references.

Intra-household correlations of nutritional status in rural Ethiopia.

BACKGROUND: It is commonly believed that households are relatively homogeneous with respect to nutritional status and occurrence of diseases. We therefore examined how anthropometric measurements are correlated between different household members in famine-prone Ethiopian communities. METHODS: We studied 1147 people in the Elka village in the Rift Valley. RESULTS: The results show that the correlations between the state of nutrition among household individuals are weak. Thus, anthropometric indices of young children, older children and adult men are an inefficient means of screening for maternal malnutrition. The low sensitivity and high specificity suggest that intra-household members may not fully share risk factors for malnutrition. CONCLUSIONS: We question the commonly held view on the use of childhood nutritional indicators as proxies of household nutritional risks. Our study may have practical implications for screening programmes and interventions during famines. There is no short cut to separate screening of population subgroups.

Growth velocity among preschool Ethiopian children.

We describe the height and weight velocities of 1529 preschool Ethiopian children from two rural and semi-urban communities. Compared to international references, our results show a marked deficit in both height and weight velocities. Most importantly, these deficits occurred among the youngest children. As most of the children had normal body proportions, the weight velocity deficits are probably a consequence of increasing prevalence of stunting alone.

Physical activity, illness and nutritional status among adults in a rural Ethiopian community.

BACKGROUND: From Africa, our knowledge on how malnutrition and diseases influence the ability to work is limited. In a one-year population-based study, we investigated the effects of nutritional status, illness and socioeconomic factors on the activity pattern in a rural population in southern Ethiopia. METHODS: From July 1991 to June 1992, 226 people (109 men and 117 women) from the Elka na Mataramofa village in the Rift Valley were examined every 3 months. Information on the occurrence of illness and measurement of nutritional status were collected every 3 months. At the same time we interviewed each person for seven consecutive days to assess the pattern of activities. RESULTS: Men and women had a mean estimated energy expenditure (SD) of 2937 kcal (951) and 1977 (513) kcal, respectively. The mean body mass index (BMI) (SD) was 19.7 (2.3) for men and 20.0 (2.6) for women. Men showed a significant seasonal variation in estimated energy expenditure that was highest during the pre-harvest time. Women did not show such a seasonal variation. In a multivariate analysis, sex, age, state of nutrition, period prevalence and severity of diseases and seasonality influenced estimated energy expenditures. CONCLUSIONS: Both low BMI and illness are significantly associated with low estimated energy expenditure. Most likely, this represents an example of the vicious circle of malnutrition, disease and activity that affects subsistence farming communities. Development work that improves the state of nutrition and health of the adult population may therefore enhance the work performance of rural populations.

PIP: The combined effects of nutrition and illness on the physical activity of subsistence farmers were investigated in a sample of 226 adults (114 households) from Ethiopia's drought-prone Rift Valley. The mean energy expenditure was estimated at 2937 kcal for men and 1977 kcal for women. Sex, age, nutritional status, period prevalence, severity of diseases, and seasonality independently influenced energy expenditure. The highest energy expenditures occurred during the pre-harvest period for men and during the harvest for women. The mean body mass index was 19.7 for men and 20.0 for women. 31.4% of men and 28.5% of women were defined as malnourished on the basis of a body mass index less than 18.5. 18.8% of respondents (20.9% of men and 17.1% of women) reported an illness in the preceding 2 weeks. Fever, headache, muscle and joint pain, malaise, and diagnosed malaria were the illnesses most frequently described. Of the 57 adults who reported a recent illness, half had stayed in bed for a mean duration of 7.8 days. Suspected, in this rural population, is a cycle of malnutrition, disease, and activity restriction that begins in childhood. Needed are interventions that reduce the prevalence of childhood stunting and health services that provide adequate prevention and treatment of diseases such as malaria.

Nutrition, maternal responsiveness and mental development of Ethiopian children.

Forty children between the ages of 16 and 42 months and their mothers, living in an Ethiopian rural village, participated in the study. The objective was to determine the mental development of the children using the Bayley Scale of Mental Development, and to examine its relation to nutritional status and mother-child interaction. Forty-eight percent of the children were mildly or moderately malnourished; 7.5% severely so. The child's weight for age was significantly related to the child's scores on the Bayley scale. Mother-child interaction was assessed through a 30-60 min observation of the pair in a naturalistic setting around the home. The number of verbal, gestural and motor actions spontaneously initiated by the mother and child, as well as responses made by each to the others' behavior were recorded and coded separately. The rate of a mother's verbal responses to the child positively predicted the child's verbal score. In contrast, the mother's spontaneously initiated motor actions toward the child correlated negatively with the child's performance score. The mother's responsiveness was unrelated to the child's nutritional status, age or sex, but was best predicted by a fussing/crying child and by her expectations about the ages when specific social-cognitive abilities would be acquired by a child.

Nutritional status and risk of infection among Ethiopian children.

This is a prospective study on the possible association between protein energy malnutrition and risk of infection in a pastoralist and in an agricultural community in southern Ethiopia. A total of 425 children under 5 years of age were observed for 8 months. In general, malnourished children had a significantly higher incidence of diarrhoeal disease, even after controlling for possible confounding social, economic, and environmental effects, as well as for past history of illness. However, the extent of this association between nutritional state and morbidity differed between the two study populations. Thus, only wasting was associated with increased incidence of diarrhoeal disease among the pastoralist, whereas wasting, stunting, low weight for age, and low arm circumference all showed such an association in the agricultural community. Demographic and socio-economic characteristics as well as differences in the prevalence of stunting may explain this discrepancy.

Population growth, fertility, mortality and migration in drought prone areas in Ethiopia.

To assess the population dynamics of drought-prone communities, we investigated 605 households in the pastoralist Boran community of Dubluk and in the agricultural community of Elka, both located in southern Ethiopia. The age and sex composition of the population as well as records of births, deaths and patterns of migration were observed for 2 consecutive years. Repeated surveys of the same households revealed much higher rates for deaths and births than did cross-sectional surveys with a one-year recall period. Indirect mortality estimates showed that the under 5 years mortality rates (per 1000 births) were 135 in Dubluk and 219 in Elka. Highest crude death rates were observed in Elka during periods of meningitis and malaria epidemics. During the period of observation, death rates fluctuated to a greater extent than birth rates. Both communities had very high rates of natural increase: in Dubluk 39.0/1000 and in Elka 37.1/1000. In Dubluk, this rate was far higher than any previously recorded and may have indicated that fertility regulating mechanisms, traditionally inherent in the pastoralist social organization, had become weaker as part of cultural changes. Dubluk represented a semi-nomadic society with a moderately high mobility pattern. Peak periods of migration coincided with times of food scarcity in Elka.

The epidemiology of lathyrism in north and central Ethiopia.

Lathyrism is a neurotoxic disorder caused by excessive, prolonged consumption of the hardy, environmentally tolerant legume, the grass-pea, Lathyrus sativus, which contains the neurotoxic amino acid beta-N-oxalylamino-L-alanine acid (BOAA). The disease develops after heavy consumption of grass-pea for over two months. It is uniformly manifested by a predominantly motor spastic paraparesis with varying degrees of disability. A door-to-door epidemiological survey for the disease using trained lay health workers was carried out in the major areas of northwest and central Ethiopia where L. sativus is grown. For security reasons, some of the other endemic areas wre not accessible for the survey. The survey involved a population of 1,011,272. A total of 3,026 affected persons were identified. The disease was found to be widespread in the northwest and central highland areas of the country. The prevalence rates ranged from 1/10,000 to 7.5/1,000. The highest prevalences were in North and South Gonder, and East and West Gojam. The male:female ratio of cases was 2.6:1; the females exhibited a milder form of the disease. The cultivation of L. sativus is increasing in Ethiopia, which makes the development of low-BOAA strains very important in order to control the high incidence of lathyrism, a crippling disease which affects the productive young members of the society.

Dietary pattern and state of nutrition among children in drought-prone areas of southern Ethiopia.

To assess dietary habits and nutritional state in drought-prone areas of southern Ethiopia, we studied 334 households in a pastoral and 282 in an agricultural community. Milk and cereals were the main sources of food among children of the pastoral Boran in Dubluk, while cereals with limited supplements of animal products or legumes formed the main sources of food among children of the agricultural population of Elka in the Rift valley. Of the children in Elka, 54.9% were stunted, as compared with 19.5% among children in Dubluk. Also, stunting occurred at an earlier age among the Elka children. Prevalences of wasting were less than 5% in both communities. Improvement in the state of nutrition of the pastoral children followed soon after the main rains, but occurred later and after the main harvest among the agricultural children. In contrast to arm circumference, the weight-for-height measure showed marked seasonal variation. Socio-economic factors, such as family wealth and crowding, significantly influenced the state of nutrition among the children. Nutritional recovery following the prolonged drought among the agricultural children was slow and associated with families acquiring more wealth.

Child health in arid areas of Ethiopia: longitudinal study of the morbidity in infectious diseases.

We describe the incidence of some childhood infections in drought prone areas of southern Ethiopia. Our results are based on 24 months' biweekly observations of 828 children aged 0-5 years in the pastoralist community of Dubluk and the agricultural community of Elka. An average of 23% of the children in Dubluk and 13% in Elka were sick during any 2-week period. Diarrhoeal diseases represented the main cause of morbidity, but the yearly number of diarrhoeal episodes were lower than previously reported from Ethiopia. Respiratory tract infections and to a lesser extent diarrhoeal diseases, showed highest incidence rates during the main dry season. The highest incidence of lower respiratory tract infections coincided with an outbreak of measles. In Dubluk, children who lived near to the wells had higher incidence rates than those who lived further away, probably reflecting the importance of crowding on transmission rates. In Elka, literacy of mothers was associated with reduced incidence of both diarrhoeal and respiratory tract infections, whereas the use of open pit latrines was associated with increased diarrhoeal incidence. The decline in disease incidence in this region during the last months of our study may reflect an improvement of nutritional status.

Lathyrism in rural northwestern Ethiopia: a highly prevalent neurotoxic disorder.

Lathyrism is a disorder of the central motor system, induced by heavy consumption of the grass-pea, Lathyrus sativus an environmentally tolerant legume containing the neurotoxic excitatory amino acid beta-N-oxalylamino-L-alanine (BOAA). A complete door-to-door resurvey of the Dembia and Fogera regions of northwestern Ethiopia, areas endemic for lathyrism, revealed an estimated mean disease prevalence of 0.6%-2.9%. Most patients developed the disease in the epidemic of 1976/77, although new cases appear to have occurred with an estimated mean annual incidence of 1.7:10,000. Production and consumption of grass-pea is increasing in Ethiopia, making attempts to develop low-BOAA strains to prevent lathyrism increasingly important.