Abortion at Gondar College Hospital, Ethiopia.

OBJECTIVE: To review the pattern and magnitude of abortion in order to establish baseline facts and data for future studies. DESIGN: A descriptive cross-sectional study. SETTING: Gondar College of Medical Sciences Hospital, Gondar, Ethiopia. RESULTS: Most of the subjects originated from the Gondar city and were married housewives, parous and relatively young. The abortion rate and ratio per 100 pregnancies and deliveries were 11.5 and 16.4, respectively. Only 13.4% of the patients admitted history of interference with the pregnancy. Previous history of abortion was obtained in 10.6% of the patients. The mean gestational ages for septic and non-septic cases were 14.6 and 15.2 weeks, respectively even though pregnancies less than 12 weeks from the last normal menstrual period accounted for 50.5%. The commonly diagnosed clinical type was incomplete, followed by inevitable and threatened abortion. The vast majority of the clinical conditions were non-septic (85.1 %) and spontaneous(85.6 %). The most common complications registered were anaemia, genital tract infection, shock of various causes and soft tissue injury. Four mothers died of abortion-related complications. The mean hospital stays for non-septic and septic abortion were three and five days, respectively. CONCLUSION: The study has attempted to address the issue of abortion in its general clinical pattern in relation to the various parameters. Being comprehensive, it also provides awareness and sensitivity on the magnitude of abortion and is assumed quite helpful for policy and decision makers.

The morphology of O. volvulus microfilaria in the northwestern onchocerciasis endemic foci, Ethiopia.

Microfilariae obtained by corneoscleral biopsy machines from persons in the Humera area along the Sudan boarder in Northwestern Ethiopia were stained using hematoxylin. Morphological measurements were made using a microscope fitted with micrometer and camera, as well as map curvimeter. The mean size of microfilariae was 189 microns by 5.8 microns. The percentage of nucleifree cephalic space as percent of total body length was 3.4 and is close to reports in the literature. The measurement of the distance of the anterior end nerve ring as a percent of the total body length (22.1%) is also close to measurements obtained elsewhere. Although the microfilaria encountered in this study are of the short variety, morphological measurements and the absence of sheath suggests that the microfilaria observed belong to O. volvulus.

Haematocrit levels and anaemia in Ethiopian children.

The paucity of data on the haematological profile of Ethiopian children prompted this survey. In October and November, 1987, a survey of haematocrit levels utilizing capillary blood and morphological studies on blood films by means of the Wright stain was conducted in the peri-urban community of Koladiba in Northwestern Ethiopia. All but 21 children (0.5-6 years) in the community participated. The mean and median haematocrit levels in children 0.5-6 years was 38% each with a range of 26-52%. Lowest haematocrit was found between 1-2 years of age. The 3rd and 97th percentile values were 31-45% and identical with the mean +/- 2 S.D. values. On a third of the children (251), blood film studies were done and 20% had microcytic hypochromic red blood cells. When an altitude corrected cut-off point of 38% was employed to define anaemia, the prevalence rate was 47.2%, the highest rate (60%) in children 1-2 years. However, use of a cut-off point based on the third percentile or +/- 2 SD (31%), resulted in an underestimation of anaemia rates by 40%. The findings of this study are consistent with previous reports on anaemia rates and haematocrit levels in Ethiopian children residing in a similar environment. Although the iron content of the Ethiopian diet is one of the highest in the world, nutritional anaemia is a public health problem. Intervention measures using iron supplementation and nutrition education through existing primary health care network are recommended.

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.

An appraisal of the epidemiologic situation of onchocerciasis in Ethiopia.

The existence of onchocerciasis in Ethiopia has been known since 1939 as a result of investigation by Italians in south-western Ethiopia. In the last fifty years onchocerciasis has been spreading to previously non-endemic regions of Ethiopia. Although comprehensive epidemiological surveys are lacking, it is estimated that 7.3 million people or 17.4% of the population of Ethiopia is at risk from this disease. The principal vectors are S. damnosum complex and S. woodi ethiopiense. The clinical picture is mainly dermal and ocular manifestations are rare. In view of agricultural development projects and resettlement of millions of people from the highlands into endemic areas in southern and north-western parts of Ethiopia, further spread of onchocerciasis is expected. Experience gained in the control of the disease in west Africa by WHO and the introduction of effective mass chemotherapeutic agents as well as primary health care programmes and activities currently underway in Ethiopia indicate the feasibility of starting control programmes. A plea is therefore made to consider the control of onchocerciasis in Ethiopia urgently.

Gene frequency and type of colour blindness in Ethiopians.

All 954 boys and 1064 girls attending two schools in north-western Ethiopia were tested in February 1988 for colour blindness using the Ishihara plates. A total of 40 colour blinds (4.2%) were found among males and 2 (0.2%) among females. There were 31 (3.2%) deutans and 9 (0.9%) protans among males. Both female colour blinds were deutans. This study confirms a previous observation on the gene frequency of colour blindness in this population. For the first time it also provides information on the frequency of this polymorphism in female Ethiopians, as well as types of red-green defects.

Spontaneous reduction in Schistosoma mansoni infection in endemic communities of the lake Tana basin, north-western Ethiopia.

The prevalence and intensity of Schistosoma mansoni infections were studied in 3 endemic communities in north-western Ethiopia using the Kato-Katz stool examination technique to determine changes in the epidemiology of schistosomiasis in the absence of control programmes. The prevalence declined in Chwahit community by 21.6%, and in the villages of Jenda and Guramba by 43.2 and 100% respectively in the course of 15 years. This spontaneous reduction in schistosomiasis is perhaps the result of recurrent drought in the area. This finding has implications for public health programmes in the area and intervention measures against schistosomiasis.

Polydrug abuse among Ethiopian university students with particular reference to khat (Catha edulis).

The pattern of use of khat (Catha edulis Forsk), alcohol, cigarettes and tranquillizers among 479 medical and paramedical students in a boarding college in northwestern Ethiopia was studied by an anonymous self-administered questionnaire. The survey coverage rate was 98.8%. The majority of students were males (82.6%) and their average age was 21.2 years. The prevalence rate of current use of alcohol, cigarettes, khat and tranquillizers was 31.1%, 26.3%, 22.3% and 7.7%, respectively. These substances were also used in combinations, the most frequent involved khat, alcohol and cigarettes. Use of khat varied by the type of training (medical/paramedical) and by phase of medical education (preclinical/clinical). These variations were also apparent when data were analysed by sex and frequency of khat use. It appears that the pattern of khat use among university students is similar to that reported for substance abuse in other countries. Because of the economic importance of khat in the Ethiopian economy, its control may be difficult at present.

Comparison between the efficacy of oxamniquine and praziquantel in the treatment of Schistosoma mansoni infections on a sugar estate in Ethiopia.

The efficacy of the antischistosomal drugs praziquantel and oxamniquine was tested on four groups of Ethiopian sugar estate workers. The cure rates, determined by the absence of eggs in stools, were 96, 93 and 74% at one, three and six months post-treatment for patients receiving a single dose (40 mg kg-1 body weight) of praziquantel, and 82, 78 and 78% for patients on a single dose (15 mg kg-1 body weight) of oxamniquine. When split doses of these drugs were used, praziquantel achieved cure rates of 96, 95 and 89%, while the corresponding cure rates for oxamniquine were 98, 96 and 88% at one, three and six months post-treatment. In general, there were no statistically significant differences within the single and split doses of each drug, nor between the two drugs except that single doses of praziquantel had significantly higher cure rates than oxamniquine at one and three months post-treatment. Although both drugs produced mild and transient side-effects such as dizziness, abdominal discomfort and diarrhoea, serious side-effects such as seizures were seen only among patients on oxamniquine. As praziquantel is also effective against other forms of schistosomiasis as well as against cestodes, we recommended the use of this drug in mass chemotherapy and in the ambulatory treatment of schistosomiasis in Ethiopia.

The epidemiology of onchocerciasis in Northwestern Ethiopia.

The prevalence of onchocerciasis has been investigated by means of quantitative skin snips for the first time in Northwestern Ethiopia. One thousand three hundred and seventy people (10%) of the population of five villages near the Sudan border were surveyed. There were 267 microfilaria carriers (19.5%) and 21 (1.5%) nodule carriers. The mean number of microfilariae per infected person was 3.6 mf/mg of skin. The infection rate in men was about three times that for women. The extent of this focus needs to be delineated.