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 (P < 0.05). CONCLUSION: It was found that Ethiopian children with rickets and without had a low calcium intake as compared to the recommended daily allowance. The fact that there was no difference in the dietary calcium intake between cases and controls and the significant difference observed between case and controls in terms of frequency of exposure to sunlight per week reflects that vitamin D deficiency emanating from poor exposure to radiant energy is the main cause of rickets in Ethiopian children. This study also documented the fact that rural children are at a higher risk of developing rickets as compared to their urban counterparts which could be mainly due to the traditional beliefs and practices more prevalent in the rural areas. Enhancing behaviour change communication about the benefits of exposing children to sunlight is very important in preventing the prevalence of rickets.

Environmental determinants of diarrheal morbidity in under-five children, Keffa-Sheka zone, south west Ethiopia.

A population-based cross-sectional study on diarrheal morbidity was carried out in thirty two rural and urban areas of Keffa-Sheka zone, to determine the prevalence of diarrhea in under-5 children and identify environmental risk factors. A total of 952 children between the ages of 0 and 59 months living in the sampled households formed the study population. Data collected include demographic characteristics of the child, and information on environmental and housing variables. The overall diarrheal prevalence was 15%. Acute watery diarrhea, dysentery, and persistent diarrhea were responsible for 66%, 20%, and 14% of the episodes, respectively. Overall a third of the diarrheal episodes were bloody and/or persistent. Young age, male gender, living in a house with fewer number of rooms, and obtaining water from storage containers by dipping showed statistically significant association with diarrheal morbidity (p < 0.05). Type of water source, amount of water consumed, and latrine availability were not found to be significant risk factors (p > 0.05). Diarrhea, particularly dysentery and/or persistent diarrhea, affect a large proportion of children. Water is scarce and the environmental status of the area is generally poor. Efforts to educate the community about correct water handling behavior, personal and domestic hygiene should also be important components of the diarrhea control strategy. Further study on other environmental determinants, socio-demographic factors, feeding patterns and immunization status of children, and ORS accessibility is also recommended.

The utility of pallor detecting anemia in under five years old children.

The diagnosis and management of anemia, which affects a significant proportion of young children in developing countries, largely depends on the clinical assessment for pallor. This study was conducted with the aim of evaluating the utility of pallor in detecting anemia. Children aged 2 to 60 months who visited the pediatric outpatient department of Jimma Hospital over 3 months period were assessed for the presence and degree of pallor in 4 anatomic sites (conjunctivae, tongue and buccal mucosa, nailbeds, palm) by trained nurses. Hemoglobin was then determined using the HemoCue method. Individuals involved in clinical examination did not have access to the laboratory results before documenting their findings. The mean hemoglobin in the 574 children examined was 11.03 gm/dl, and about 46% had anemia. Children younger than 2 years were found to have a higher prevalence of anemia as compared to older children (p < 0.001). Palmar pallor, with a sensitivity of 58%, had the highest sensitivity to detect moderate anemia as compared to other anatomic sites. The presence of either palmar or conjunctival pallor increased the sensitivity to 73%. The inter-observer agreement was highest for conjunctival pallor (kappa value = 0.81). The findings of the study suggest that pallor of a single anatomic site does not have adequate sensitivity to detect moderate anemia. We recommend further studies to look at the performance of severe pallor in correctly identifying severe anemia. Furthermore, the magnitude and causes of anemia need to be studied in a community setting.

Dietary practices and xerophthalmia 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 XIB 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, preferably combined with immunisation, should be a priority action, and parents need to be educated about vitamin A deficiency and its prevention.

Protein-energy malnutrition in urban children: prevalence and determinants.

Between February and April 1995, 669 under-five children living in Jimma town were randomly selected and had their nutritional status assessed. Risk factors for protein-energy malnutrition (PEM) were also studied. About half (48%) of the children were found to be malnourished. The prevalence of underweight, wasting and stunting were 36%, 9% and 36%, respectively. Severe protein-energy malnutrition, i.e., marasmus, kwashiorkor and marasmic-kwashiorkor, was detected in 2%. The prevalence of malnutrition was lowest in infants. While underweight and wasting peaked by the second and third years of life, stunting increased dramatically by the second year and peaked in the fifth year. Poor socio-economic background, poor housing condition, non-availability of latrine, "unprotected" water source, an attack of pertussis, not completing immunization, prolonged breast feeding and nutritionally inadequate diet were found to be risk factors for PEM in the bivariate analyses. Multiple logistic regression analyses showed a strong association between PEM and poor housing condition, non-availability of latrine, prolonged breast feeding and diet lacking in animal food. Intervention measures should take the multifactorial causation of PEM into consideration.

Diarrhoea morbidity in an urban area of southwest Ethiopia.

A diarrhoea morbidity survey was conducted in children between the ages of six and 59 months in Jimma town, southwest Ethiopia. Nearly 37% of the 820 children surveyed had one or more episodes of diarrhoea over a period of one month preceding the study. Although several factors showed significant association with diarrhoea morbidity on bivariate analysis, child's age, immunisation status, father's ethnicity, family income and availability of latrine were the only significant variables on multivariate analysis. Based on the study results feasible intervention measures are recommended.

PIP: A morbidity survey conducted among 820 children 6-59 months of age from Jimma town, southwest Ethiopia, during the 1995 rainy season revealed that 299 (36.5%) had experienced at least 1 diarrhea episode in the month preceding the study. A total of 554 diarrhea episodes were recorded. Children aged 24 months and younger were more likely to have had diarrhea than their older counterparts (odds ratio (OR), 3.22; 95% confidence interval (CI), 2.36-4.40). Other factors significantly associated with diarrhea in the multivariate analysis were immunization (OR, 0.57; 95% CI, 0.35-0.90), Oromo paternal ethnicity (OR, 1.45; 95% CI, 1.04-2.02), family income of Birr 150 or less (OR, 1.55; 95% CI, 1.10-2.19), and the availability of a private latrine (OR, 0.57; 95% CI, 0.40-0.81). Infant feeding patterns and child nutrition status were not associated with diarrhea after possible confounding factors were controlled. These findings indicate a need for child health interventions aimed at educating mothers about the importance of measures such as immunization and safe waste disposal.