Prevalence and mortality rate of sepsis among adults admitted to hospitals in sub-Saharan Africa: a systematic review and meta-analysis.

Due to abundant pathogen diversity and mounting antimicrobial resistance, sepsis is more common in sub-Saharan Africa (sSA). However, there is a lack of consistent reports regarding the prevalence of adult sepsis in the region. Therefore, this study aimed to determine pooled estimates of sepsis prevalence and associated mortality among adults admitted to hospitals in sSA. Medline (through PubMed), Scopus, Embase, and Web of Science were systematically searched for studies of sepsis in sSA published before 13th February 2023. A random-effects meta-analysis of hospital-wide and intensive care unit (ICU)-based sepsis prevalence was performed with a 95% confidence interval (CI). Subgroup analysis was conducted considering geographic region and sepsis diagnostic criteria. Funnel plots and Egger's test were used to assess publication bias. The protocol was submitted to the Prospective Register for Systematic Reviews (PROSPERO) with an identifier (CRD42023396719). Overall, 14 observational studies, published between 2009 and 2022, from eight different sSA countries comprising 31,653 adult patients (5723 with sepsis) were included in the review. Nine studies that were conducted in a hospital-wide setting showed a pooled prevalence and mortality of 17% (95% CI: 12-21%) and 15% (95% CI: 17-35%), respectively. Five studies in the ICUs presented a pooled prevalence and mortality of 31% (95% CI: 24-38%) and 46% (95% CI: 39-54%), respectively. Based on the sub-group analysis, the pooled hospital-wide prevalence of sepsis in East and Southern Africa was 18% (95% CI: 11-25%), and 20% (95% CI: 2-42%), respectively. The pooled prevalence in the ICU was 14% (95% CI: 4-23%) and 13% (95% CI: 5-20%) for East and Southern Africa, respectively. The hospital-wide and ICU-based sepsis prevalence and mortality are high in sSA. Addressing the burden of adult sepsis should be a priority for healthcare systems in sub-Saharan Africa.

Genomic Regions and Candidate Genes Associated with Milk Production Traits in Holstein and Its Crossbred Cattle: A Review.

Genome-wide association studies (GWAS) are a powerful tool for identifying genomic regions and causative genes associated with economically important traits in dairy cattle, particularly complex traits, such as milk production. This is possible due to advances in next-generation sequencing technology. This review summarized information on identified candidate genes and genomic regions associated with milk production traits in Holstein and its crossbreds from various regions of the world. Milk production traits are important in dairy cattle breeding programs because of their direct economic impact on the industry and their close relationship with nutritional requirements. GWAS has been used in a large number of studies to identify genomic regions and candidate genes associated with milk production traits in dairy cattle. Many genomic regions and candidate genes have already been identified in Holstein and its crossbreds. Genes and single nucleotide polymorphisms (SNPs) that significantly affect milk yield (MY) were found in all autosomal chromosomes except chromosomes 27 and 29. Half of the reported SNPs associated with fat yield and fat percentage were found on chromosome 14. However, a large number of significant SNPs for protein yield (PY) and protein percentage were found on chromosomes 1, 5, and 20. Approximately 155 SNPs with significant influence on multiple milk production traits have been identified. Several promising candidate genes, including diacylglycerol O-acyltransferase 1, plectin, Rho GTPase activating protein 39, protein phosphatase 1 regulatory subunit 16A, and sphingomyelin phosphodiesterase 5 were found to have pleiotropic effects on all five milk production traits. Thus, to improve milk production traits it is of practical relevance to focus on significant SNPs and pleiotropic genes frequently found to affect multiple milk production traits.

Diagnostic value of Xpert MTB/RIF assay on pleural tissue obtained via closed pleural biopsy among persons with presumptive tuberculous pleuritis.

BACKGROUND: Tuberculous pleuritis (TBP) is a common extrapulmonary tuberculosis that contributes to the tuberculosis burden. Xpert MTB/RIF assay is a promising method for rapid diagnosis of TBP. The diagnostic value of Xpert MTB/RIF assay in pleural tissue obtained via closed pleural biopsy among sputum acid-fast bacilli (AFB) smear-negative persons is not well studied. OBJECTIVES: To evaluate the diagnostic value of Xpert MTB/RIF assay on diagnosis of TB in pleural tissue obtained via blind closed pleural biopsy. METHODS: Closed pleural biopsy using Cope needle was performed on adult patients who presented with lymphocyte predominant exudative pleural effusion. Xpert MTB/RIF assay was performed in parallel to pathology and mycobacterial culture of the pleural tissue specimen to determine its sensitivity and specificity. Final clinical diagnosis of TBP was determined by improvement in 2-months follow-up of anti-tuberculous treatment. RESULTS: A total of 33 patients were included in the study. The median (interquartile range (IQR)) age was 27 (25 - 42) years. The sensitivity and specificity of Xpert MTB/RIF assay was 30% and 100% compared with Mycobacterium tuberculosis culture as the gold standard, and 20% and 95.7% compared with histopathology as the gold standard. CONCLUSION: Xpert MTB/RIF assay in pleural tissue obtained by closed pleural biopsy did not increase diagnostic yield, but it shortens time for diagnosis compared with conventional methods.

Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths averted by kangaroo mother care versus mortality due to SARS-CoV-2 infection.

BACKGROUND: COVID-19 is disrupting health services for mothers and newborns, particularly in low- and middle-income countries (LMIC). Preterm newborns are particularly vulnerable. We undertook analyses of the benefits of kangaroo mother care (KMC) on survival among neonates weighing ≤2000 g compared with the risk of SARS-CoV-2 acquired from infected mothers/caregivers. METHODS: We modelled two scenarios over 12 months. Scenario 1 compared the survival benefits of KMC with universal coverage (99%) and mortality risk due to COVID-19. Scenario 2 estimated incremental deaths from reduced coverage and complete disruption of KMC. Projections were based on the most recent data for 127 LMICs (~90% of global births), with results aggregated into five regions. FINDINGS: Our worst-case scenario (100% transmission) could result in 1,950 neonatal deaths from COVID-19. Conversely, 125,680 neonatal lives could be saved with universal KMC coverage. Hence, the benefit of KMC is 65-fold higher than the mortality risk of COVID-19. If recent evidence of 10% transmission was applied, the ratio would be 630-fold. We estimated a 50% reduction in KMC coverage could result in 12,570 incremental deaths and full disruption could result in 25,140 incremental deaths, representing a 2·3-4·6% increase in neonatal mortality across the 127 countries. INTERPRETATION: The survival benefit of KMC far outweighs the small risk of death due to COVID-19. Preterm newborns are at risk, especially in LMICs where the consequences of disruptions are substantial. Policymakers and healthcare professionals need to protect services and ensure clearer messaging to keep mothers and newborns together, even if the mother is SARS-CoV-2-positive. FUNDING: Eunice Kennedy Shriver National Institute of Child Health & Human Development; Bill & Melinda Gates Foundation; Elma Philanthropies; Wellcome Trust; and Joint Global Health Trials scheme of Department of Health and Social Care, Department for International Development, Medical Research Council, and Wellcome Trust.

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia.

BACKGROUND: In Ethiopia, neonatal mortality accounts for approximately 54% of under-five deaths with the majority of these deaths driven by infections. Possible Severe Bacterial Infection (PSBI) in neonates is a syndromic diagnosis that non-clinical health care providers use to identify and treat newborns with signs of sepsis. In low- and middle-income countries, referral to a hospital may not be feasible due to transportation, distance or finances. Growing evidence suggests health extension workers (HEWs) can identify and manage PSBI at the community level when referral to a hospital is not possible. However, community-based PSBI care strategies have not been widely scaled-up. This study aims to understand general determinants of household-level care as well as household care seeking and decision-making strategies for neonatal PSBI symptoms. METHODS: We conducted eleven focus group discussions (FGDs) to explore illness recognition and care seeking intentions from four rural kebeles in Amhara, Ethiopia. FGDs were conducted among mothers, fathers and households with recruitment stratified among households that have had a newborn with at least one symptom of PSBI (Symptomatic Group), and households that have had a newborn regardless of the child's health status (Community Group). Data were thematically analyzed using MAXQDA software. RESULTS: Mothers were described as primary caretakers of the newborn and were often appreciated for making decisions for treatment, even when the father was not present. Type of care accessed was often dependent on conceptualization of the illness as simple or complex. When symptoms were not relieved with clinical care, or treatments at facilities were perceived as ineffective, alternative methods were sought. Most participants identified the health center as a reliable facility. While designed to be the first point of access for primary care, health posts were not mentioned as locations where families seek clinical treatment. CONCLUSIONS: This study describes socio-contextual drivers for PSBI treatment at the community level. Future programming should consider the role community members have in planning interventions to increase demand for neonatal care at primary facilities. Encouragement of health post utilization could further allow for heightened accessibility-acceptability of a simplified PSBI regimen.

One Health collaborations for zoonotic disease control in Ethiopia.

Zoonotic diseases require a One Health approach for successful control and elimination due to the nature of their transmission between animals and humans. One Health recognises that the health of humans, animals, and the environment are all interconnected. Ethiopia has committed itself to controlling five prioritised zoonotic diseases (rabies, anthrax, brucellosis, leptospirosis and echinococcosis), using a One Health approach. The National One Health Steering Committee (NOHSC) provides a framework for national stakeholders to address gaps in multisectoral communication, coordination and collaboration. In addition, the NOHSC oversees the formation of several specialised disease-focused groups, referred to as 'Technical Working Groups' (TWGs). These TWGs are responsible for developing disease prevention and control strategies, as well as implementing disease-focused public health activities and providing recommendations to the NOHSC. Ethiopia's success using the One Health approach and its efficient control of zoonotic diseases will depend on the commitment of all member Ministries to support the NOHSC and TWGs, as well as to build capacity in Ethiopia's workforce and laboratories, a task supported by its many international partners.

Les zoonoses étant par nature des maladies transmissibles entre les animaux et l'homme, l'approche Une seule santé est la seule qui permette de les contrôler efficacement en vue de les éliminer. Le concept Une seule santé repose sur la prise en compte de l'interconnexion entre la santé humaine, celle des animaux et celle de l'environnement. L'Éthiopie s'est fixé pour objectif de lutter contre cinq maladies zoonotiques classées comme prioritaires (rage, fièvre charbonneuse, brucellose, leptospirose et échinococcose) en suivant une approche Une seule santé. Le comité de pilotage national Une seule santé (NOHSC) apporte un cadre permettant aux parties prenantes du pays de résoudre les problèmes de communication, de coordination et de collaboration intersectorielles. En outre, le NOHSC supervise la création de plusieurs groupes de travail techniques dédiés à des maladies spécifiques. Ces groupes de travail sont chargés d'élaborer des stratégies de prévention et de contrôle, de mettre en oeuvre des activités de santé publique axées sur ces maladies et de formuler des recommandations à l'intention du NOHSC. La réussite des efforts déployés par l'Éthiopie pour appliquer les principes Une seule santé et l'efficacité de la lutte contre les maladies zoonotiques dépendront de l'engagement des ministères concernés à soutenir le NOHSC et les groupes de travail techniques et à renforcer les capacités des ressources humaines et des laboratoires éthiopiens, tâche qui bénéficie de l'appui de nombreux partenaires internationaux.

Toda labor eficaz de control y eliminación de las enfermedades zoonóticas, por la propia naturaleza de su transmisión entre animales y personas, pasa por abordar estas patologías desde los planteamientos de Una sola salud, noción esta que parte del reconocimiento de que salud humana, animal y ambiental están siempre interconectadas. Etiopía está embarcada en el innegociable empeño de combatir cinco enfermedades zoonóticas consideradas prioritarias (rabia, carbunco bacteridiano, brucelosis, leptospirosis y equinococosis) trabajando desde la óptica de Una sola salud. El Comité Directivo Nacional de Una sola salud proporciona a los interlocutores del país un marco de referencia que sirve para subsanar las lagunas existentes en cuanto a comunicación, coordinación y colaboración entre los diversos sectores. Ese órgano, además, supervisa la formación de varios grupos especializados y centrados en una u otra enfermedad, denominados grupos de trabajo técnicos, que tienen por cometido elaborar estrategias de prevención y control de una enfermedad concreta, llevar adelante acciones de salud pública dirigidas contra ella y formular recomendaciones para el Comité Directivo. El éxito de Etiopía a la hora de aplicar los postulados de Una sola salud y de combatir eficazmente las enfermedades zoonóticas dependerá del nivel de compromiso con que todos los ministerios copartícipes presten apoyo al Comité Directivo y los grupos de trabajo técnicos y ayuden a instaurar en el país un tejido lo bastante solvente de laboratorios y recursos humanos, empresa esta en la que Etiopía cuenta con el respaldo de sus numerosos asociados internacionales.

Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a diagnostic evaluation study.

OBJECTIVES: The diagnosis of extrapulmonary tuberculosis (EPTB) is often made on clinical suspicion alone, resulting in both under- and overdiagnosis and relatively poor outcomes. In this study, we evaluated the clinical utility of the Xpert MTB/RIF on routinely collected extrapulmonary specimens in Ethiopia. METHODS: This study was carried out at Jimma University Specialized Hospital, Southwest Ethiopia. Extrapulmonary specimens were collected from 572 patients clinically suspected of suffering from EPTB. All specimens were tested for TB by smear microscopy, culture, and Xpert MTB/RIF. The diagnostic accuracy of Xpert MTB/RIF was calculated and compared to a composite reference standard (CRS), comprising clinical and laboratory results. RESULTS: In total, 572 extrapulmonary specimens (279 lymph node, 159 pleural, 80 peritoneal, 45 cerebrospinal, and nine pericardial fluids) were tested. The pooled sensitivity and specificity of Xpert MTB/RIF were calculated to be 75% (95% CI 70-80) and 98% (95% CI 97-100) respectively when compared to the CRS. The highest sensitivity was documented for lymph node specimens (90%; 95% CI 86-94), moderate sensitivity for cerebrospinal fluid (53%; 95% CI 28-79), while the sensitivity was lowest for pleural (30%; 95% CI 17-44) and peritoneal (32%; 95% CI 12-51) fluids. Xpert MTB/RIF in addition detected rifampicin resistance in 13 patients, in perfect agreement with results from the line probe assay. CONCLUSIONS: Xpert MTB/RIF may be used as initial diagnostic tool for testing of lymph node specimens from patients suspected of having TB lymphadenitis. The added value of Xpert MTB/RIF to diagnose pleural or peritoneal TB is limited by its poor sensitivity.

Collective Efficacy: Development and Validation of a Measurement Scale for Use in Public Health and Development Programmes.

Impact evaluations of water, sanitation, and hygiene interventions have demonstrated lower than expected health gains, in some cases due to low uptake and sustained adoption of interventions at a community level. These findings represent common challenges for public health and development programmes relying on collective action. One possible explanation may be low collective efficacy (CE)-perceptions regarding a group's ability to execute actions related to a common goal. The purpose of this study was to develop and validate a metric to assess factors related to CE. We conducted this research within a cluster-randomised sanitation and hygiene trial in Amhara, Ethiopia. Exploratory and confirmatory factor analyses were carried out to examine underlying structures of CE for men and women in rural Ethiopia. We produced three CE scales: one each for men and women that allow for examinations of gender-specific mechanisms through which CE operates, and one 26-item CE scale that can be used across genders. All scales demonstrated high construct validity. CE factor scores were significantly higher for men than women, even among household-level male-female dyads. These CE scales will allow implementers to better design and target community-level interventions, and examine the role of CE in the effectiveness of community-based programming.

Mercury Human Exposure in Populations Living Around Lake Tana (Ethiopia).

A survey carried out in Lake Tana in 2015 found that Hg levels in some fish species exceeded internationally accepted safe levels for fish consumption. The current study assesses human exposure to Hg through fish consumption around the Lake Tana. Of particular interest was that a dietary intake of fishes is currently a health risk for Bihar Dar residents and anglers. Hair samples were collected from three different groups: anglers, college students and teachers, and daily laborers. A questionary includes gender, age, weight, activity. Frequency of fish consumption and origin of the eaten fish were completed by each participant. Mercury concentrations in hair were significantly higher (P value <0.05) for anglers (mean ± standard deviation 0.120 ± 0.199 µg/g) than college students (mean ± standard deviation 0.018 ± 0.039 µg/g) or daily workers (mean ± standard deviation 16 ± 9.5 ng/g). Anglers consumed fish more often than daily workers and college group. Moreover, there was also a strong correlation (P value <0.05) between the logarithms of total mercury and age associated with mercury concentration in scalp hair. Mercury concentrations in the hair of men were on average twice the value of the women. Also, users of skin lightening soap on a daily basis had 2.5 times greater mercury in scalp hair than non-users. Despite the different sources of mercury exposure mentioned above, the mercury concentrations of the scalp hair of participants of this study were below levels deemed to pose a threat to health.

Prevalence of mastitis and brucellosis in cattle in Awassa and the peri-urban areas of two smaller towns.

The prevalence of mastitis and brucellosis in urban and peri-urban settings was studied in Awassa and two smaller nearby towns in southern Ethiopia, because milk-born diseases are causing a risk for human health, besides direct impacts on animal production. Mastitis was investigated by examining 80 cows (320 udder quarters) using California mastitis test (CMT) and somatic cell count (SCC). The prevalence of brucellosis was assessed by sampling 177 cattle in Awassa and its peri-urban areas using serological methods. Logistic regression was used to analyse risk factors associated with mastitis. Prevalence of clinical mastitis on quarter level was 0.9%, and 1.9% of quarters were non-functional or blocked. Prevalence of sub-clinical mastitis at quarter level in urban and peri-urban areas was significantly different (P < 0.05). Cows in large herds and at advanced lactation number were associated with higher risk of infection. The percentage of quarters positive on CMT (42.5%) was close to the percentage-positive detected by SCC (41.2%). Prevalence of brucellosis was 3.9% in the peri-urban area, while no brucellosis cases were detected in Awassa. More frequent use of artificial insemination in the urban than in peri-urban area might have contributed to the absence of brucellosis in the urban location. The extent of mastitis is, however, a threat to the dairy enterprise in and around Awassa. Pasteurization of milk and milk products is indicated in some parts of the area because of the danger of brucellosis.

SUPPORT FOR THE CONTINUATION OF FEMALE GENITAL MUTILATION AMONG ADOLESCENTS IN JIMMA ZONE, SOUTHWEST ETHIOPIA.

BACKGROUND: Female genital mutilation/cutting is a harmful practice which has effect on female's wellbeing. However, the practice has continued to prevail in many cultures. Research on the social determinants of the practice and its continuation are scarce. The objective of this study was to assess whether attitude towards the continuation of female genital mutilation is predicted by gender role perception among adolescents in Jimma zone. METHODS: This study used data collected in the first round of Jimma Longitudinal Family Survey of Youth. A total of 2084 adolescents were identified from 3700 households and one adolescent were interviewed from each household using structured questionnaire. Data on the socio-demographic characteristics, religiosity, access to electronic media, perception of gender role, attitude towards continuation of Female circumcision was collected. Descriptive and multivariate statistical techniques were used to analyze the data using SPSS for windows version 16.0. Statically tests were performed at the level of significance of 5%. RESULTS: Of the 2084 adolescents, 1146 (55.0%) were aged 12-14 years, 1025 (49.2%) females and 749 (35.9%) from rural areas. The majority, 1289 (61.9%) were Muslims and 1351 (64.8%) Oromo. Five hundred seventy three (28.1%) of the male youth did not agree to the importance of marrying a circumcised girl. However, 149 (13.8%) and 258 (12.7%) agreed that it is very important and important, to marry a circumcised girl, respectively. On multivariate logistic regression analysis, perception of gender role, sex, place of residence, highest education in the household and religion remained to be important predictors of attitude towards the continuation of female genital mutilation after adjustment for age and ethnicity. Adolescents who had low gender role perception were 1.4 times more likely to have a positive attitude towards the continuation of the female genital mutilation (OR: 95%CI, 1.41: 1.02-1.94). Female adolescents were 36% less likely to support (P<0.01) the continuation of FGM compared to their male counter parts (OR: 0.64; 95%CI: 0.49, 0.83). Compared to urban youth, those who live in semi urban and rural areas were 1.46 and 1.52 times more likely to have a positive attitude towards the continuation of the FGM practice, respectively (P<0.05). Similarly the Probability of having positive attitude towards the continuation of the FGM practice decreased steadily as the highest educational level in the household increased. CONCLUSION: One-fifth of the youth support the continuation of the practice. Low gender roles perception, being from the rural areas, household's lower level of education and being Muslim were strong predictors of the attitude towards the continuation of female genital mutilation. Improving perception of adolescents towards gender roles through effective behavior change communication, and involving religious leaders in the campaign against the practice of female genital mutilation is recommended as a useful strategy to ban the practice.

Biting flies and Trypanosoma vivax infection in three highland districts bordering lake Tana, Ethiopia.

An epidemiological study was conducted to determine the prevalence of trypanosomosis in cattle, small ruminants and Equidae, and to identify biting flies; potential mechanical vectors of trypanosomes in the three districts of Bahir Dar Zuria, Dembia and Fogera, bordering lake Tana, Ethiopia. About 1509 cattle, 798 small ruminants and 749 Equidae were bled for the prevalence study using the buffy-coat method and the measurement of the hematocrit value. Sixty-six NGU and 20 monoconical traps were deployed for the fly survey. The results indicated the presence of trypanosomes in 6.1% (92/1509) of the cattle with a maximum during the late rainy season (9.6%) than the early dry season (3.6%) at Fogera district. Prevalence at the district level varied from 4% to 9.6%. Only one sheep (1/122) and one goat (1/676) were found positive for T. vivax-like trypanosomes and none of the Equidae was positive. All the trypanosomes encountered in cattle belong to the single species of T. vivax. The PCV was negatively associated with detection of T. vivax (21.6% in infected versus 25.4% in non-infected cattle). A total of 55,398 biting flies were caught of which 49,353 (89.08%) belong to Stomoxys, 4715 (8.51%) to horse flies and 1330 (2.4%) to Chrysops species. There was no tsetse fly. Species identification has indicated the presence of Atylotus agrestis, Chrysops streptobalia, Stomoxys calcitrans, S. nigra, S. pulla, S. pallida, S. sitiens, S. taeniata, S. uruma, Haematopota lasiops and Hippobosca variegata. The overall apparent density was 214.7flies/trap/day. Seasonal comparison showed higher fly catches in the late rainy season than the early dry season. This study indicated that T. vivax infections culminate in cattle at the same time as mechanical vectors such as Stomoxys sp. and Atylotus agrestis. Therefore, attention towards T. vivax infection in cattle is essential to control the impact of the disease on productivity. A further study on biting flies is recommended.

Drug-resistant Trypanosoma congolense in naturally infected donkeys in north Omo Zone, southern Ethiopia.

A three-part study was conducted to determine the efficacy of isometamidium chloride in donkey populations naturally infected with trypanosomes in north Omo Zone, southern Ethiopia. In the first, 373 randomly selected donkeys from four villages were examined for trypanosome infections by the dark ground/phase contrast buffy coat technique (BCT) in November 1999. The trypanosome prevalence was 18.2% (95% confidence interval (CI): 14.4, 22.5) and Trypanosoma congolense was the most common species accounting for 66.2% of the overall infections. In the second part, 40 infected donkeys were selected and treated with a prophylactic dose of 1.0mg/kg of isometamidium chloride and thereafter monitored every 14 days for 90 days. Trypanosomes were detected in eight donkeys within 1 month and in 20 donkeys within 2 months of treatment. About 16% (5/32) of donkeys infected with T. congolense were detected parasitemic 1 month after treatment. In addition, the result also revealed that all relapse/breakthrough infections were due to T. congolense. In the third part of this study mice were infected with two T. congolense field isolates from donkeys that were found to be parasitemic within 1 or 2 months after isometamidium treatment. The mice were treated with ranges of doses of isometamidium chloride or diminazene aceturate and thereafter followed for relapse infection. Isometamidium chloride at doses 0.5-4 mg/kg body weight and diminazene aceturate at doses of 3.5-28 mg/kg body weight failed completely to cure T. congolense infections in any of the mice.

Multiple-drug resistant Trypanosoma congolense populations in village cattle of Metekel district, north-west Ethiopia.

Investigations were carried out to determine the prophylactic activity of isometamidium chloride in village populations of cattle naturally infected with trypanosomes in Metekel district, northwest Ethiopia. In a cross-sectional study in March 1997, 484 randomly selected cattle from four villages were examined for trypanosome infections by the dark ground/phase contrast buffy coat technique (BCT). The trypanosome prevalence was 17.2%. Trypanosoma congolense was the dominant species accounting for 47.6% of the overall infections. Fifty parasitaemic cattle from two villages were treated with isometainidium chloride (Trypamidium(R)) at a prophylactic dose of 1.0 mg/kg body weight (b.w.) and thereafter monitored on a monthly basis for parasitaemia. Trypanosomes were detected in six cattle within 1 month and in 18 cattle within 2 months of treatment. Twenty three percent (6/26) of cattle infected with T. congolense at the time of treatment were detected parasitaemic with this trypanosome species 1 month after treatment. Mice were infected with three T. congolense isolates obtained from cattle which were detected parasitaemic within one or 2 months after isometamidium treatment. The mice were subsequently treated with ranges of doses of isometamidium chloride or diminazene aceturate (Berenil(R)) and thereafter monitored for parasitaemia for a period of 60 days. Isometamidium chloride at doses of 0.5-4.0 mg/kg b.w. and diminazene aceturate at doses of 3.5-28.0 mg/kg b.w. failed to cure T. congolense infections in any of the animals. Three clones were derived from one of the isolates; each clone expressed high levels of resistance to both trypanocides when tested in mice. Based on these results it is concluded that the prophylactic activity of isometamidium is greatly reduced for some of the T. congolense populations present in the area, and in addition there is resistance to diminazene aceturate in this trypanosome species.

Birth interval and pregnancy outcome.

A cross-sectional study was conducted from September to March 1993 at maternity ward of Jimma Hospital to asses the pattern and determinants of birth interval and the role of contraceptive in influencing the length of birth interval. The information was collected by use of pre-tested questionnaire from 415 mothers by three midwives trained for this purpose. The variables examined were: information on parity, use of contraceptive methods during the preceding birth intervals, breast feeding and some demographic variables such as age, martial status, education. Pregnancy outcome variables such as, live births, stillbirths, abortion and infant deaths. Slightly over seventy five per cent of the study subjects were aged 20-29 years, 59% and 27% were para 2-3 and 4-5 respectively. In more than 81% of the subjects, the birth interval was less than three years with a mean birth interval of 22.1 months. Approximately two per cent used contraceptive when the birth interval was 12 months and less. Stillbirth and early neonatal deaths accounted for 3.2% and 6.9% respectively. Based on the findings, we underscore the importance of birth spacing using the available family planning methods to promote safe motherhood and achieve better child survival.

PIP: This study examines pregnancy outcomes and the patterns of birth intervals and their determinants, particularly contraceptive usage, among 415 women who delivered at Jimma Hospital during September 1992 to March 1993 in Ethiopia. Midwives interviewed mothers regarding age, marital status, income, education, parity, contraceptive usage, duration of breast feeding, and pregnancy outcomes. The sample of 415 mothers reported 2009 pregnancies and 1594 birth intervals. 9.2% of the women were single, 88.5% were married, and 2.3% were divorced or separated. 50.2% were illiterate and 42.4% had some elementary schooling. 12.9% were aged under 20 years and 75.4% were aged 20-29 years. 59.0% had a parity of 2-3 and 27% had a parity of 4-5. 81% of birth intervals were under 36 months; the mean interval was 22.1 months. 13.2% of birth intervals were under 12 months, 68% of birth intervals were 13-36 months, and 45.9% of birth intervals were under 24 months. 32.2% of intervals under 12 months resulted in spontaneous abortion and 13.2% of 12-24 month intervals resulted in spontaneous abortion. The stillbirth rate was 3.2%, and the neonatal death rate in the first week of life was 6.9% among birth intervals under 12 months. 42.3% of birth intervals under 12 months resulted in pregnancy wastage: abortion, stillbirth, or neonatal mortality. The proportion of pregnancy wastage declined with an increased birth interval. 32.5% of mothers used contraception. 1.9% of birth intervals under 12 months and 17% of 13-36 month birth intervals were found among contracepting mothers. 89.5% of mothers exclusively breast-fed for 4-6 months, of whom 31.3% had a return to menstruation.

Trypanosoma congolense in the microvasculature of the pituitary gland of experimentally infected Boran cattle (Bos indicus).

The pituitary glands of seven Boran cattle (Bos indicus), five infected with a clone of Trypanosoma congolense IL 1180 (ILNat 3.1) transmitted by Glossina morsitans centralis and two uninfected controls, were examined by light and electron microscopy 43 (experiment 2) or 56 (experiment 1) days after fly challenge. The three cattle used in the first experiment included a 15-month-old female (No. 1), a 24-month-old female (No. 2), and a 21-month-old male (No. 3) as a control. In the second experiment, four cattle were used: two females (Nos. 4, 5) and one male (No. 6), all between 15 and 24 months of age, and one female control (No. 7) of similar age. In all the infected animals, dilation of both the sinusoids and microvasculature was apparent, as was an increase in the thickness of the extracellular matrix between the pituitary lobules. Trypanosomes were found in the microvasculature of the adenohypophysis and neurohypophysis in all the infected animals. Focal degenerative changes were seen in the adenohypophyseal section of glands from the infected animals euthanatized 56 days post-infection. These degenerative structural changes were confined to the somatotrophic cells. The possible role that trypanosomes in the microvasculature may play in inducing pituitary damage and dysfunction is discussed.

Reduced responsiveness of the hypothalamic-pituitary-adrenal axis in Boran (Bos inducus) cattle infected with Trypanosoma congolense.

The response of the pituitary-adrenal axis to corticotrophin-releasing hormone (CRH) and the adrenal response to adrenocorticotrophin hormone (ACTH) stimulation were studied during infection of Boran (Bos indicus) cattle with Trypanosoma congolense. For CRH, 15 animals were challenged during preinfection and infection phases, while for ACTH 10 animals were challenged during pre-infection, infection and post-treatment phases of the experiments. The axis showed a reduced responsiveness after CRH challenge during patent parasitaemia, manifested by low (p < 0.05) plasma ACTH and cortisol concentration as compared to the pre-infection CRH challenge concentrations. Cortisol concentration after ACTH challenge during pre-infection, infection and post-treatment phases did not differ. The reduced pituitary-adrenal response to CRH challenge and the normal adrenal response to ACTH challenge found during trypanosomiasis indicates pituitary dysfunction due to infection.