Development of a high-rate submerged anaerobic membrane bioreactor.

Typically, anaerobic membrane bioreactors are operated at an organic loading rate (OLR) less than 10 kg chemical oxygen demand (COD)/m3 d. This paper discusses the development and performance of a high-rate submerged anaerobic membrane bioreactor (SAnMBR) for a high-strength synthetic industrial wastewater treatment. An OLR as high as 41 kg COD/m3 d was achieved with excellent COD removal efficiency (>99%). The membrane was operated at constant fluxes (9.4-9.9 ± 0.5 L/m2 h) and the change in trans-membrane pressure (TMP) was monitored to characterize the membrane performance. The results showed a low TMP (<5 kPa) under steady-state operation with only biogas sparging and relaxation as control strategy for over 300 days, implying no significant fouling was developed. Inorganic fouling was the dominant fouling mechanism occurred at the end of the study. The results suggest that the newly developed SAnMBR configuration can treat high-strength wastewater at lower capital expenditure while still providing superior effluent quality for water reuse or system closure.

Community perception on OPD performance of a teaching hospital in Gondar town.

Among 2605 heads of households interviewed in Gondar Town, 1,099 (42%) had visited the Out Patient Department of the Gondar College of Medical Sciences Hospital during the past one year. Of these, 856 (78%) were dissatisfied with the services. The pharmacy was perceived as the worst unit of the Department. Among the 1,042 visitors who had gone to the pharmacy, 76% were unable to buy all the drugs prescribed by the physicians. The outcome of treatment as perceived by the visitors were 671 (61%) improved and 71 (7%) died at home after seeking consultation at the OPD. Mechanisms of improving hospital performances such as greater community participation and improved management system are suggested.

Performance of health workers after training in integrated management of childhood illness in Gondar, Ethiopia.

The performance of six primary health workers was evaluated after following a 9-day training course on integrated management of childhood illness (IMCI). The participants were selected from three primary health centres in the Gondar District, Ethiopia, and the course was focused on assessment, classification, and treatment of sick children (aged 2 months to 5 years) and on counselling of their mothers. Immediately following this training, a 3-week study was conducted in the primary health centres to determine how well these workers performed in assessing, classifying and treating the children and in counselling the mothers. A total of 449 sick children who presented at the three primary health centres during the study period were evaluated. Most of the complaints (87%) volunteered by the mothers (fever, cough, diarrhoea, and ear problems) were covered by the IMCI charts. The assessment of commonly seen signs (tachypnoea or ear pain) or easily identifiable signs (slow return after skin pinch, wasting, or pedal oedema) was good, with sensitivities of 67-91%, whereas the assessment of uncommonly seen signs (dry mouth, corneal clouding) or less easily quantifiable signs (eyelid pallor, absence of tears) had a fair or poor sensitivity of 20-45%. The classification of pneumonia, diarrhoea with signs of dehydration, and malnutrition showed sensitivities of 88%, 76%, and 85% and specificities of 87%, 98%, and 96%, respectively. However, the classification of febrile illnesses had a sensitivity of only 39% due to problems in using the draft algorithm in areas with a mixture of high, low, and no malaria risk, and due to confusion between axillary and rectal temperature thresholds. Of 39 children classified as having severe disease, 9 were misclassified, mostly by one nurse. Treatment of patients improved over the three weeks of observation, their completeness increasing from 69% to 88%. Health workers usually communicated appropriate advice to the mother. They learned to use checking questions but failed to adequately solve problems in the majority of cases. The mother's counselling card, which summarized recommendations on feeding and home fluids, and advice on when to return, was widely used to aid communication. The time taken to perform the complete management of children did not change significantly (20 to 19 minutes) during the study. Lessons from our findings have been incorporated into an improved version of the IMCI charts.

PIP: 6 outpatient clinic nurses selected from 3 primary health centers in the Gondar District of Ethiopia were trained over the course of 9 days in the integrated management of childhood illnesses (IMCI), after which their performance was evaluated. The training course focused upon the assessment, classification, and treatment of sick children aged 2 months to 5 years, and upon the counselling of their mothers. Immediately following the training, the trainees were observed working in the health centers for a 3-week period to determine how well they assessed, classified, and treated children, and counseled mothers. 449 children who presented at the centers during the study period were evaluated. 87% of the complaints noted by the mothers on fever, cough, diarrhea, and ear problems were covered by the IMCI charts. There was good assessment of commonly seen signs such as tachypnoea and ear pain, as well as of readily identifiable signs such as a slow return after skin pinch, wasting, and pedal oedema; sensitivities were 67-91%. However, sensitivities were only 20-45% for rarely seen signs such as dry mouth and corneal clouding and the more difficult to recognize signs of eyelid pallor and the absence of tears. The classification of pneumonia, diarrhea with signs of dehydration, and malnutrition had sensitivities of 88%, 76%, and 85%, and specificities of 87%, 98%, and 96%, respectively. The classification of febrile illnesses was 39% sensitive. 9 of 39 children with severe disease were misclassified, mostly by one nurse. Patient treatment improved over the 3 weeks of observation and health workers usually communicated appropriate advice to mothers.

Prevalence and intensity of S. mansoni infection along the shores of Lake Tana, Ethiopia.

The prevalence and intensity of infection along the shores of Lake Tana was studied. Out of 472 students examined the prevalence of S. mansoni was 29% (CI = 25%, 33%). The intensity of infection was moderate (Geometric chi eggs per gram of stool = 289). Of the 137 positive, 21.2% had heavy infections (> 800 epg). The prevalence and intensity of infection was high in the age group 10-14 years. Reduction in morbidity is recommended as top priority in the control of schistosomiasis.

Health behaviour of rural mothers to acute respiratory infections in children in Gondar, Ethiopia.

One hundred and thirty two mothers in a rural area were interviewed to determine how they recognize pneumonia and what type of treatment they propose for pneumonia and mild ARI. Most mothers recognized pneumonia by grunting fast breathing and high fever, but only 35.6% of them propose taking these children to the health centre. Health damaging traditional practices particularly for mild ARI are widespread. Information regarding prevailing beliefs and practices in childhood ARI have a policy implication in the formulation of health education strategy for ARI control.

PIP: During November-December 1990 in northwestern Ethiopia, medical students interviewed 132 mothers with at least 1 child younger than 5 years old living in the villages of Dembosge, Koladuba, and Gondar so researchers could assess the mothers' knowledge, attitudes, and practices regarding acute respiratory infections (ARI) in their children. All the mothers were married Christians from the Amhara tribe. 61.4% were illiterate. Most mothers recognized that respiratory rate (77.3%), high fever (76.5%), and decreased feeding (62.8%) were important signs of pneumonia. They all knew that grunting was also an important sign. Only 35.6% would take their child with these symptoms to a nearby health center. Other common treatments were taking the child to a traditional healer (64.4%) and applying butter and herb to the chest via a massage at home (95.5%). Traditional practices were the predominant interventions proposed by the mothers for mild ARI (e.g., cold, sore throat, and ear discharge). Most (58.3%) mothers proposed to clean the ear and to keep it dry. 85.6% of mothers would take their child with a sore throat to a traditional healer for tonsil extraction, a hazardous practice. The only treatment for mild ARI associated with maternal education was tonsil extraction by a traditional healer. Specifically, illiterate mothers were more likely to seek this treatment for their ill child than literate mothers (91% vs. 76%; p = 0.03). Effective ARI health education needs to be based on understanding the prevailing knowledge, beliefs, and practices of the mothers. Thus, the national ARI control program in Ethiopia should consider these findings when developing ARI policy.

Assessment of hospital management needs.

During 1993/94, a study was done through a mailed self-administered questionnaire to identify specific hospital management needs. Out of 73 hospitals, 29 (39.7%) were covered in the study. Of the 29 medical directors, 16 (55.2%) were general practitioners and 25 (86.2%) did not have any formal training in hospital management. Lack of financial resource, shortage of medical supplies and equipment and low motivation of health personnel were considered top problems. The need for improving hospitals by providing appropriate training, involving communities, developing strong supervision and control are suggested.

Intensity of infection and reinfection rate of A. lumbricoides in a rural farming village, Dembia district, northwest Ethiopia.

The purpose of this study was to determine the intensity of infection and reinfection rate of A. lumbricoides at a village in Dumbia District, Northwest Ethiopia. It was done in June 1992 and repeated in June 1993. Among 192 examined for intestinal parasites, the prevalence rate was 60.9%. Infection with A. lumbricoides was 34.4%. Children in the age-group 1-4 years had the highest egg count (arithmetic mean of 3040 eggs per gram of stool) for A. lumbricoides. Reinfection rate after 11 months among those treated against A. lumbricoides was 53%. The study has an important implication in understanding the local epidemiology of A. lumbricoides and in the design of community-based control programmes.

Review of the academic performance of medical students in Gondar

Academic performance results measured in CGPA and ESLCE score of medical school of Gondar College of Medical Sciences were reviewed. Out of 900 students admitted from 1979 to 1987; only 530 (58.9 percent) graduated. The reported attrition rate was 41.1 percent. Poor correlation (r=0.32) was detected between ESLCE result and final CGPA. A difference in academic performance between males and females was observed during the early phases of medical education. The validity of the ESLCE result as a sole admission criteria is discussed

Attitude of medical students to future practice characteristics.

In November 1990, 14.5% of the 271 medical students of the Gonder College of Medical Science (G.C.M.S.), Gonder, Ethiopia, were of peasant background. Only 10.2% of the 271 expressed willingness to serve for more than two years in the rural areas after graduation, and, of those not willing, a higher proportion (15.5%) were from the main towns than from rural areas (1.2%). Specialty choice of senior students showed obstetrics-gynaecology, other specialties such as dermatology, internal medicine and surgery as the most preferred career goals. In addition, 67.2% of the students agreed that there is a greater need for physicians in rural than urban settings, agreement being six times more frequent by Clinical Year I students than interns (referent group). Among twelve personal and professional variables suggested, continuing education, schools for children, and private practice were considered better in urban than in rural areas. The study has important implications for medical education.

Epidemiology of common transmissible skin diseases among primary school children in north-west Ethiopia.

A total of 1842 school children were examined for the occurrence of common transmissible skin infections in a rural area in North-West Ethiopia. The result showed a prevalence rate of 49.2%. Tinea capitis, impetigo, infected wounds and verrucae vulgaris were common. In addition the overall prevalence rate of lice infestation was 55.4%. The findings indicated the need to develop appropriate intervention programmes both at school and community levels.

[Epidemiology of communicable skin diseases in school children of a rural area in North Ethiopia]. / Zur Epidemiologie übertragbarer Hautkrankheiten bei Schulkindern einer ländlichen Gegend Nordäthiopiens.

The pupils of 5 elementary schools in the Dembia-District in Northethiopia were inspected in serial examinations. The transmissible skin diseases head lice infestation, tinea capitis, impetigo contagiosa and verrucae vulgares are very common among the unselected children (5 to 15 years old). Only 16% of all children had not any infectious skin disease. The investigations showed the unfortunate conditions of the poor hygiene those are existing in the rural areas of a developing country in the tropics.

Traditional child health practices in communities in north-west Ethiopia.

PIP: A study in 3 villages in northwest Ethiopia was designed to find the type and extent of health damaging traditional child practices. The result of the survey showed high rates of uvulectomy and milk teeth extraction, and low rates of eyelid incision and female circumcision. More than 84.5% and 98.8% of the mothers surveyed, respectively, reported milk teeth extraction as a useful treatment for diarrhea and eyelid incision in the treatment of eye disease. The damage done by milk teeth extraction includes complications from unhygienic conditions (e.g. ostitis and osteomyelitis). Although many children survive these ill advised procedures and their complications, the considerable damage done to some of the children makes these procedures serious health hazards. Intensive health education with relevant health activities to correct the use of these traditional practices is advised.^ieng