Xerophthalmia and malnutrition among pre-school children in Agaro town south-west Ethiopia.

A community-based cross-sectional study was undertaken in Agaro town to determine the magnitude of xerophthalmia and malnutrition in January 1993. 434 children (aged six months to six years), were selected randomly and by using the proportionate probability sampling technique from the eight 'kebeles' of the town. Data were collected by interviewing mothers/ care-takers of index children and by ocular and anthropometric examinations. From the total subjects studied, the proportion of males (54.6%) was higher than females (45.3%). Few mothers/ care-takers (24.5%) were found to be illiterate. According to the Waterloo classification, 18.6% were either wasted, stunted or both. The overall prevalence of xerophthalmia was 6.2%. Being malnourished and earning less than 700 birr / year were significantly associated with xerophthalmia (chi 2 = 6.23; P < 0.05). Finally, children with clinical signs of xerophthalmia and other eye diseases were treated accordingly and advice was given to mothers/care-takers of malnourished children.

Blood-cerebrospinal fluid barrier integrity in cerebral infarction.

Using a sensitive isotachophoretic technique total cerebrospinal fluid protein, CSF-serum albumin and CSF-serum IgG ratios as indicators of blood-CSF barrier integrity were determined in 35 cases of ischemic cerebral infarction. Since it proved to be changed in about 57% of these patients, the CSF-serum albumin ratio was found to be the most sensitive parameter in evaluating the blood-CSF barrier disturbances. No clear-cut correlation was found between the age of patients, the clinical course of the disease, different periods after onset of the illness nor the size of the infarction and CSF-blood barrier permeability.

Community-based study of neurological disorders in Ethiopia: development of a screening instrument.

This paper describes the development of a screening instrument for a community-based neuroepidemiological survey in a rural community in Ethiopia. A pilot study in 1984 to pre-test the questionnaires developed revealed that epilepsy, poliomyelitis, mental retardation and speech disturbances were the most common neurological disorders among the 3,000 rural inhabitants surveyed. The study suggested that a base-population of about 50,000 was required for a future major epidemiological survey to identify rare neurological disorders.

Menstrual regulation in Bangladesh: an evaluation of training and service programs.

This article evaluates the performance of three urban menstrual regulation (MR) training and service programs in Bangladesh. Virtually all of the MR providers including physicians and paramedics in the three centers received training in various MR procedures by means of demonstration or class lectures. However, a significant proportion of the trained MR providers were unable to render proper MR services due to the lack of clinical facilities and lack of equipment. Analysis of follow-up data for MR clients revealed that those women who utilized MR procedures offered through the centers had an average of about three live births. Physician providers were more likely to serve clients from a higher socioeconomic strata, while paramedical providers were more likely to serve MR clients from lower socioeconomic strata or agricultural background. Most of the clients receiving MR services were ever and current users of contraceptives and developed fewer complications from MR procedures than those served by untrained traditional herbalists, healers or birth attendants.

PIP: Although induced abortion is illegal in Bangladesh, the Government has made menstrual regulation available since 1975 for the prevention of unwanted pregnancies. By 1985, a total of 2399 physicians and 7093 family planning paramedical workers had been trained to provide menstrual regulation in selected clinics throughout the country. Between 1975 and 1985, 286,500 menstrual regulation procedures had been performed in Bangladesh. This study evaluated the performance of 3 urban menstrual regulation training and service programs through interviews with both service providers and clients. Nearly all the service providers has been trained in pre and post-menstrual regulation counseling, contraindications, and treatment of complications and learned about the various menstrual regulation procedures through class lectures or demonstration. While 64% of the physician providers interviewed indicated they felt fully confident about performing menstrual regulation at the conclusion of their training, only 28% of the paramedical providers expressed this confidence. Moreover, a significant proportion of trained providers were unable to render services due to a lack of clinical facilities, lack of sterilization, or the absence of equipment such as syringes. In terms of clients, those who received the menstrual regulation procedure from a physician were more likely to be of higher socioeconomic status and to have the procedure performed in a hospital. Paramedical providers were more likely to serve clients from an agricultural background. Complications occurred in 173 of the 1365 clients interviewed (especially bleeding and abdominal pain), but there were no significant differences in complication rates between the 2 categories of providers. 82% of menstrual regulation clients were found to be using contraception at a follow-up interview. More widespread use of menstrual regulation could reduce the maternal deaths resulting from clandestine abortions; however, this study indicates a need for improvements in clinical facilities and equipment.

Trends and differentials in knowledge, ever use, current use, and future intended use of contraceptives in rural Bangladesh: evidence from three surveys.

PIP: Data were drawn from 3 major surveys conducted between 1968-77 in Bangladesh to examine the trends and differentials in knowledge, ever and current use of contraception, and future intended use of contraception among the rural population. Logit analysis was used to estimate net effects of socioeconomic and demographic factors. Data utilized covered "currently married" women from the Impact of Family Planning Survey (IFPS) (n = 2522), the World Fertility Survey (WFS) (n = 4117), and the Rural Fertility and Poverty Survey of 1975 (RFPS) (n = 1247). Since the RFPS data were from rural areas, they were compared with corresponding data from rural samples in the IFPS and WFS. The diffusion pattern of knowledge, current and ever use, and future intended use of contraceptives by parity and age of respondents in rural Bangladesh are given for the years 1968-77. There was a steady increase in knowledge and practice of family planning over the years. Knowledge of contraceptives increased from 63% in 1968 to about 94% in 1977. Current use also increased from 3.6% in 1968, 1975, and 1977, ever, current, and future intended users and knowledge of contraceptives tended to be positively and moderately related to respondents' educational levels, nonagricultural occupation, and number of living children. The same also was true of educational levels of respondents' husbands. No consistent relationship was found between these factors and ideal family size, but overall ideal family size declined somewhat by 1977, reflecting a change in family size preference that prevailed across sociodemographic groups. No major sociodemographic differences in the rate of change in ever, current, and future intended uses of contraceptives appeared to emerge between 1968-77. Table 3 shows the net results of the multivariate analysis of the dependent variables by logit regression technique. The most important variables associated with ever, current, and future intended uses of contraceptives were parity and education level of the respondents. In 1968, 1975, and 1977, individuals with more children or with higher educational attainment were more likely to seek fertility limitation measures, but the effect of living children seemed to have decreased over the years. This declining coefficient of living children suggested more increases in contraceptive use and future contraceptive intent among younger or lower-parity mothers.^ieng

Son preference in Bangladesh: an emerging barrier to fertility regulation.

PIP: This study investigates the effect of son preference on contraceptive use and desire for additional children using national level survey data from Bangladesh for the years 1969 and 1979. National probability samples of ever married women between the ages of 10 and 50 were selected and stratified by urban-rural residence. Specifically, the study focuses on contraceptive use and desire for additional children and separates the effect of sex preference from that of high parity on fertility control. Son preference has a negative effect on contraceptive use and a positive effect on the desire for additional children regardless of socioeconomic and demographic characteristics. This advese effect of son preference on fertility regulation seemed to have persisted over the years. Relevent socioeconomic conditions in Bangladesh are described. In 1979, the effect of sex composition on contraceptive use or desire for additional children varied by parity. The negative effect of fewer living sons on contraceptive use and its positive effect on desire for additional children was higher in parities between 2 and 4 than in other parities. The effect of sex composition was stronger on desire for additional children than on contraceptive usage. In 1969, however, there was no consistent positive relationship between sex composition and contraceptive use. The relationship between sex composition and desire for more children was positive. Among women of parities 2 to 4, an excess of daughters continued to have a major positive effect on desire for additional children, and a negative effect on contraceptive use, after controlling for other sociodemographic variables. For parities 1 and 5 or above, the effect was either weak or inconsistent.^ieng

Knowledge of family planning methods in Bangladesh, 1969-1979: trends and implications.

PIP: The changes in levels of knowledge about different contraceptive methods in Bangladesh between 1969-79 were assessed. 2 surveys provided the data: the 1969 National Impact Survey (NIS) of family planning and the 1979 Contraceptive Prevalence Survey (CPS) from Bangladesh. Both surveys were nationally representative and retrospective, containing detailed questions of pregnancy histories, socioeconomic background, family planning knowledge and attitude, and contraceptive practices. The sampling frames for both surveys consisted of all households in Bangladesh from which national probability samples of married women between the ages of 10-50 were selected and stratified by urban-rural residence. Unprompted data were analyzed. Apparently, the National Family Planning Program (NFPP) was successful in communicating general knowledge of family planning among the masses in Bangladesh. In terms of absolute level, the increase in general knowledge of family planning was from 46.3% in 1969 to 82.8% in 1979. With the exception of the oral contraceptive (OC), absolute increase in knowledge of specific family planning methods or a variety of methods was far less than that of general knowledge of family planning. Knowledge of condoms, female sterilization, and male sterilization increased between 1969-79, yet in terms of absolute levels these increases were far less than those of either general knowledge of family planning or knowledge of OCs. The percentages of couples reporting knowledge of the IUD, vaginal methods, rhythm, injection, or induced abortion either decreased or slightly increased between 1969-79. Nearly 40% of couples had knowledge of only 1 method; fewer couples knew of 2 or more methods. There were relative increases in the knowledge of OCs and female sterilization, an 8-fold increase in knowledge of the OC and a 6-fold increase in knowledge of female sterilization between 1969-79. Respondents from the urban areas or those who attended schools were more likely to know about different contraceptive methods. Despite government orders stipulating that each household be visited every month by a family planning worker, face-to-face contact with family planning extension workers continued to be very low. In view of poor field worker performance, the government has made various modifications in the NFPP operation aimed at strengthening information and service delivery programs, yet recent evidence shows their continuing ineffectiveness. The low levels of knowledge about different family planning methods and low level of contact between family planning workers and family planning target couples show that the NFPP, by failing to inform married couples of wider choice of methods, missed many potential new acceptors of family planning methods.^ieng

Acute hemiplegia of infancy and childhood in Addis Ababa: report on 50 followed up cases.

From 1978 to 1982, 50 consecutive cases of acute infantile and childhood hemiplegias were followed up at our Neurology clinic. Fifteen cases (30%) were below the age of two years and 34 cases under five years of age (68%). Our youngest patient was six months and the oldest 13 1/2 years. The male to female ratio was 1.3:1. An acute onset of hemiplegia was noted in 64% of cases. A right side hemiplegia was more common than a left (1.5:1). Idiopathic cases, where no clinical associations could be made, bacterial meningitis, head traumas, and encephalitis were the four leading causes of acute hemiplegias in our series. (A complete recovery was noted in 82% of cases without associated clinical causes.) Subsequent development of epilepsy was noted in 10% of cases at follow-up.