African Journals Online
The Ethiopian Journal of Health Development
(EJHD)

Official Journal Of The Ethiopian Public Health Association
Volume 16, Number 3, December, 2002

Primary care treatment of epilepsy in Rural Ethiopia

Shibru Berhanu¹, Shitaye Alemu¹, Jilalu Asmera¹, Martin Prevett²

Abstract

Background: Chronic non-communicable diseases, such as epilepsy, are increasingly recognised as important health care problems in developing countries. Despite cheap effective treatment, the majority of people with epilepsy remain untreated. In northern Gondar, Ethiopia, we have established a treatment program for epilepsy at a primary care level.

Method: Nurse-led clinics were set up at five rural health centers. Nurses from each health center received training in the management of epilepsy at Gondar College of Medical Sciences (GCMS).

Result: Over an 18 month period from April 1998, 813 patients, aged 1-75 years (median age 20) with active epilepsy were registered and started on Phenobarbitone. The duration of epilepsy ranged from 1 month to 50 years (median 4 years) and 87% had not previously been treated with antiepileptic drugs. In only 4% due to an inability to pay for the drugs and more than 90% were unaware that medical treatment existed.

Conclusion: It is possible to provide effective epilepsy treatment using existing health care infrastructure in the country with few additional resources. [Ethiop.J.Health Dev. 2002;16(3):235-240]

Ruptured uterus-eight year retrospective analysis of causes and management outcome in Adigrat Hospital, Tigray Region, Ethiopia

Amanael Gessessew1, Mengiste M Melese2

Abstract

Background: Ruptured uterus is a common cause of maternal and perinatal mortality and morbidity. Further studies may help in the development of preventive strategies.

Objective: To determine the frequency, cause and management outcome of ruptured uterus at a zonal hospital.

Method: A retrospective study (April 1, 1993-March 30, 2001) was done to describe the frequency, cause, treatment, complications, and maternal and fetal mortality associated with ruptured uterus. A structured questionnaire was used to collect information from delivery registration books, operation room records, and patient cards.

Result: A total of 54 cases of ruptured uterus and 5,980 hospital deliveries were recorded for a ratio of 1:110. Causes of rupture were: cephalopelvic disproportion (53.7%), malpresentation and malposition (25.9%), instrumental (3.7%), pitocin induced (3.7%), uterine scar (11.2%) and placenta percreta (1.8%). Most were multipara and rupture was complete in 94.4%. Site of rupture was in lower uterine segment in 58.5% and left lateral in 24.5%. Ten cases (18.5%) had associated bladder injury. Total abdominal hysterectomy was performed in 20 (37%), subtotal abdominal hysterectomy in 13 (24.2%) and repair in 21 (38.9%) cases. Vesicovaginal fistula and wound infection were common post-operative complications. Maternal case fatality rate was 11.1% and fetal case fatality rate was 98.1%. Ruptured uterus contributed 24% of all causes of maternal deaths in the hospital within the study period.

Conclusion: This calls for an integrated effort to prevent the causes of uterine rupture and ensure prompt management to reduce maternal and perinatal mortality and morbidity. [Ethiop.J.Health Dev. 2002;16(3):241-245]

The role of men in fertility and family planning program in Tigray Region

Gebrekidan Mesfin

Abstract

Objective: To assess men's role on fertility and their attitudes towards family planning, to compare in which ways and to what extent they differ from their wives/partners and its implications for future family planning programs.

Design: The study involved a cross-sectional comparative study design. Both closed and open-ended questionnaires were used.

Subject: The study included couples of the reproductive age group, who were married or in union for greater than six months at the time of the survey. Four hundred and ten respondents (205 men and 205 wives/partners) were included.

Setting: sub-Districts-Mekelle and Kuha (urban and semi-urban) in Tigray, Ethiopia.

Main outcome measures: Couples' fertility intentions, ideal mean family size preferences and attitude towards family planning.

Results: The study for the two sample proportions showed that Tigrian men in general wanted a greater number of children than their wives/partners (²=11.08, df=1,P<0.001). Men showed greater family size preferences (ideal family size) than their wives/partners (4.9 children for men and 3.7 for women). Differences for the two groups are statistically significant, with 95% CI: 1.2(0.87 to 1.53). The data on current use of family planning versus husbands' approval showed strong association, (²=8.88, df=2,P=0.012\).

Conclusion: Men's fertility intentions, reproductive preferences and their attitude towards family planning seem to influence the fertility behavior of their wives and their attitudes towards the use of modern contraceptives. Traditional socio-cultural norms, economic and property ownership status mean that Tigrian men dominate decision-making at all levels of the reproductive processes. Men's attitudes towards family planning (which was assessed in terms of partner approval and discussion were important in determining the role of husbands regarding the use of family planning methods by women, and on the fertility level of the family. Therefore in an attempt to promote reproductive health through the increasing use of modern contraceptives, family planning programs need to target men specifically at all levels of the program. Men should be actively involved at 'knowledge' level, 'supportive' level and 'acceptor' level. Their decision-making role should be used (exploited) in order to promote contraceptive use by couples in the study population. [Ethiop.J.Health Dev.2002; 16(3):247-255].

The problems of female students at Jimma University, Ethiopia, with some suggested solutions

Asresash Demise, Ruth Shinebaum , Kassahun Melesse

Abstract

Background: Education is perhaps the single essential measure to ensure a full participation of women in development. Women's participation in all fields of the world has become significant. Objective: This study was conducted to identify gender related problems of female students in Jimma University (JU).

Methods: This study is a cross-sectional study undertaken using quantitative and qualitative methods, in which the university community (staff and students of both sexes) participated.

Results: The problems most frequently cited were violence, harassment and lack of security. Lack of facilities and assertiveness, workload, and academic performance were mentioned less often. In particular, awareness towards the existence of gender discrimination in campus diverge between males (30%) and females (64%), P< 0.001. However, the solutions suggested focused on raising awareness, guidance and counseling, academic support and improvement of facilities.

Conclusion: This study strongly suggests that in order to improve female achievement in tertiary education, attention should be given to personal security, material support and assertiveness creation in addition to academic needs. [Ethiop.J.Health Dev. 2002;16(3):257-266]

Cost-effectiveness Analysis of Health Care Interventions in Meskanena Mareko Wereda, Ethiopia

Ababi Zergaw¹, Damen Haile Mariam², Ahmed Ali²

Abstract

Background: Decisions concerning the implementation of health programs are usually made on the basis of descriptive assessment. There are only few attempts to review whether returns from investment on these programs worth the effort.

Objectives: To analyze and evaluate the cost-effectiveness of health care interventions in terms of lessening disease burden and improving health status in a rural community.

Methods: The evaluation was conducted in health institutions in Meskana Mareko Wereda and in Shashemene Hospital that were purposively selected. Study subjects were people utilizing these facilities. Data on inputs of interventions were analyzed using the Disease Burden Modeling System and Disability Adjusted Life Years (DALYs) gained was used as a measure of effectiveness of interventions.

Results: Interventions at health stations level were most cost-effective compared to those at health center and the hospital. Generally, community and preventive interventions were found to be more cost-effective in lessening existing burden of disease (BOD) in the local community and in improving the general health status of the populations with cost of less than 5 Birr per DALY gained.

Conclusions: Implementing 22 health care interventions with cost of less than 100 Birr per DALY gained at the health stations level will avert 52% of the BOD in the area. On the other hand implementing 17 interventions at the hospital and 18 interventions at the health center level will avert only about 22 to 34% of the BOD. Given the availability of information pertaining to the local BOD and cost-effective intervention options, there appears to be a dire need to review local health priorities and intervention strategies. [Ethiop.J.Health Dev. 2002;16(3):267-276]

Knowledge and practice of condom in preventing HIV/AIDS infection among commercial sex workers in three small towns of northwestern Ethiopia

Gegu Degu Alene

Abstract

Background: HIV/AIDS is a serious problem in Ethiopia. Currently, about 2.6 million people are living with the virus. The majority of the studies on HIV/AIDS and condom use carried out elsewhere in this country have very much limited themselves in big urban centers. This study is aimed at investigation of the knowledge and use of condoms among commercial sex workers in the prevention of HIV/AIDS in three rural towns of northwestern Ethiopia.

Objectives: the objective of the study was to assess the knowledge and use of condom among commercial sex workers aged 15 to 49 in the prevention of HIV/AIDS. Moreover, the influence of selected factors on the use of condom was also aimed to be examined.

Methods: a cross-sectional study was conducted in Kola Duba, Chuahig and Dabat towns (rural towns) between October and December 1999. Data were collected from 317 commercial sex workers using a pre-tested questionnaire.

Results: the level of knowledge of commercial sex workers about HIV/AIDS (97.2%) and condom (96.2%) was stated to be very high compared to their experience of using condom (32.5%) in general and frequent use of condom (12.8%), in particular. Condoms were reported to be readily available at a fair (cheap) price. Among the partners of commercial sex workers who did not like to use condoms, the majority (81%) were farmers who come to those small towns from the surrounding rural areas. A higher condom use rate was observed as the level of educational status of commercial sex workers increased from lower to higher grades (trend test, P<.01).

Conclusion: Besides the initiation of poverty alleviation programmes, a more focused educational intervention for commercial sex workers of rural towns should be given due attention. [Ethiop.J.Health Dev. 2002;16(3):277-286]

Environmental risk factors and the development of trachomatous trichiasis in Dalocha District, Central Ethiopia: a case-control study

Ameha Bogale, Abebe Bejiga

Abstract

Background: Trachoma is the second leading cause of blindness in Ethiopia. Even in trachoma hyperendemic areas, not all member of the community develop trichiasis. Whether this is due to uneven exposure or other factors is not clear. This necessitated a case-control study to see the extent of exposure among these groups.

Objective: The purpose of the study was to assess the extent of exposure to known environmental risk factors among cases with trachomatous trichiasis and age, sex and location matched controls with no trachomatous trichiasis in Dalocha District, Central Ethiopia.

Methods: all patients with clinically diagnosed trachomatous trichiasis (TT) according to the WHO definition for TT and an equal number of sex and location matched controls with no trachomatous trichasis were subjected to an interviewer administered questionnaire consisting of questions assessing family size, number of children raised, frequency of face washing, water sources and distance from it in minutes, location of kitchen, toilet waste disposal, place for cattle at night and some more considered to be related with repeated trachomatous infection.

Results: One hundred ninety seven cases with TT and an equal number of controls were the study subjects. Regression analysis of individual risk factors showed that irregular face washing practice (odds ratio (OR))=2.27;95% confidence interval (CI):1.48-3.49) and being illiterate (OR=0.34;CI:0.18-0.64) were significantly associated with the development of TT. Regarding face washing, this significance was also maintained in a logistic regression analysis of the variables where the type of water used for washing and the frequency of cooking were also positively associated with TT.

Conclusion: Improved educational status and regular face washing of the community may decrease the likelihood that people will be at risk of developing TT and its blinding complications. [Ethiop.J.Health Dev. 2002;16(3):287-293]

Metals in leafy vegetables grown in Addis Ababa and toxicological implications

Fisseha Itanna

Abstract

Background: Vegetables grown at environmentally contaminated sites in Addis Ababa could take up and accumulate metals at concentrations that are toxic to human health.

Objective: To analyze the metal/metalloid contents of some leafy vegetables in Addis Ababa with emphasis on their toxicological implications.

Method: Recently matured leaf samples of cabbage, Swiss chard, and lettuce at early maturity, from Peacock Park and Kera vegetable farms underwent pressurized digestion with HNO₃/H₂O₂ to determine heavy metals.

Results: Cabbage was in general the least accumulator of metals/metalloids. Lettuce and Swiss chard grown at Kera had higher concentrations of metals/metalloids compared to those grown at the Peacock Park. In a few cases, As, Cr, Fe and Pb in these vegetables have surpassed maximum permitted concentrations, while Cu deficiency was observed in cabbage.

Conclusions: Metal uptake differences by the leafy vegetables is attributed to plant differences in tolerance to heavy metals. Vegetables from Kera consisted of higher metal/metalloids than from Peacock Farm because Kera River is more contaminated than Bulbula River. The intake of most of the metals constitutes less than 10% of the TMDI (theoretical maximum daily intake) at present, and hence health risk is minimal. But with increase in vegetable consumption by the community the situation could worsen in the future. Treatment of industrial effluents and phyto-extraction of excess metals from polluted environments could reduce health risk. [Ethiop.J.Health Dev. 2002;16(3):295-302]

Crowding in a traditional rural housing (“Tukul”) in Ethiopia

Abera Kumie¹ , Yemane Berhane²

Abstract

Background: Poor housing condition is one of the major public health concerns in many developing nations due to its association with the health status.

Objectives: To determine the size of traditional “Tukul” by altitudinal zone in rural communities.

Methods: During a census enumeration 5113 rural housing units were physically assessed. Axis, radius, and wall height were measured to the nearest centimeter by trained enumerators using a tape meter.

Results: The mean (±SD) values of axis, radius, and wall height were found to be as 537.92cm (±84.88), 329.43cm (±64.81), and 236.38cm (±22.65), respectively. The mean (±SD) space for floor area was 35.43 (13.72)m² and space by indoor volume was 123.42 (60.26)m³ per habitable “Tukul”. According to the WHO literatures for a dwelling units, about 85% of the “Tukuls” in a rural area are crowded and far behind to satisfy the physiological needs of a resident. Nearly 95% of housing units had only one room.

Conclusions and Recommendations: The high magnitude of overcrowding in rural housing units indicates the poor living and sanitation conditions. As this predisposes to many adverse health conditions, appropriate interventions need to be done with out delay. [Ethiop.J.Health Dev. 2002;16(3):303-308]

Stroke Admission to Tikur Anbassa Teaching Hospital: With Emphasis on Stroke in the Young

Bekele Alemayehu, Kebede Oli

Abstract

Background: Although the burden of cerebrovascular accident is not known in Africa, including Ethiopia, it s a frequent cause of mortality and morbidity in hospital practice. Stroke in the young is associated with different spectrum of risk factors and treatment outcome as compared to stroke in the older age group.

Method: To assess potential risk factors associated with stroke; and to compare the types and frequencies of these potential risk factors among stroke in the young and stroke in the older age groups, a retrospective case study of all stroke patients admitted to Tikur Anbassa Teaching Hospital over six years period, September 1990 to August 1996, was undertaken.

Results: Two hundred and fifty nine patients satisfying the definition of stroke were admitted to Tikur Anbassa Teaching Hospital. Stroke in the young accounted for 28% (73 patients). Hypertension was the commonest risk factor among both age groups. Rheumatic heart diseases (RHD) was the second commonest risk factor after hypertension present in 29% of stroke in the young while it was absent in the older age. All the RHD cases had mitral valve involvement (mainly mitral stenosis), nearly all having milder forms of the disease. Only 9 of 21 patients with RHD had established atrial fibrillation.

Conclusion: Rheumatic heart disease is an important risk factor among stroke in the young and type of valve involved rather than severity of disease is related to occurrence of stroke. If confirmed on subsequent prospective studies this finding will have an impact on indication for anticoagulation in RHD. [Ethiop.J.Health Dev. 2002;16(3):309-315]

Laboratory studies on the outbreak of Gangrenous Ergotism associated with consumption of contaminated barley in Arsi, Ethiopia

Kelbessa Urga¹, Asfaw Debella¹, Yeshi W/Medihn¹, Agata N², Abebe Bayu³, Wubalem Zewdie⁴

Abstract

Background: Ergotism is caused by the fungus Claviceps purpurea, which parasitizes cereal grains and is ingested by man through flour milled from contaminated cereals. An outbreak of ergotism in Ethiopia in 1978 resulted from exposure to ergot alkaloids from C. puruprea sclerotia.

Objectives: The objective of this study was to investigate consumption of cereal grains grown locally as the most likely cause of the outbreak of gangrenous ergotism so that control measures could be applied.

Methods: During June to August, 2001, there were reports of a large number of cases of gangrene in Arsi Zone, Ethiopia. A multi-disciplinary team assessed the outbreak of the decease. Non-structured in-depth interviews were conducted with heads of households of the affected, and each of the patients was also interviewed. Grain samples were then collected from the interviewed households and analyzed for ergot alkaloids. Acute toxicity studies were also conducted by feeding male, non-pregnant and pregnant Swiss albino mice with the collected grain samples.

Results: Mycological cultures of grain samples yielded ergot alkaloids. All the grain samples contained ergot alkaloids, but with varying concentration. The highest concentration of ergotamine was observed in grain samples No. 4 (2.51 mg/100 g) and No. 6 (2.66 mg/100 g). Grain samples No. 2 and 7 had similar concentration of ergotamine, but more than four-fold higher than in grain sample No. 3. In contrast, the concentration of ergometrine in grain samples No. 4 (1.15mg/100 g) and No.6 (1.21mg/100 g) were two-fold lower than ergotamine. The highest death (55%) of mice was observed in those test groups fed on grain samples No. 4 and No. 6. Cases of abortion were noted after 3 days of feeding in all pregnant mice with the exception of those allocated to grain sample No. 3.

Conclusion: We conclude on the basis of these results that the outbreak of gangrene in Arsi Zone, Ethiopia, is attributed to the ingestion of barley containing ergotized wild oats. [Ethiop.J.Health Dev. 2002;16(3):317-323]

Effect of Khat (Catha edulis Forsk) on blood pressure & heart rate, a community based study

Andualem Mossie Ayana¹, Hassen Taha Sherief², Yemane Tekli³

Abstract

Background: The plant khat (Catha edulis Forsk) growing in some regions of East Africa including Ethiopia, has a peculiarity of producing certain influences on the physical, physiological and psychosocial well being of the community using it frequently.

Objective: The main aim of this work is to determine the prevalence and sociodemographic profile of khat chewing and its effect on the blood pressure and heart rate. So far there is no community-based study that has been done in Ethiopia to determine the adverse effect of chronic khat chewing on the cardiovascular system.

Methods: In this study, a cross-sectional, house-to-house survey on the representative sample of 1000 persons, age 16 years, was conducted in Jimma town, south western Ethiopia, from January to September 2001. Sociodemographic data were collected and vital signs such as blood pressure and heart rate were measured before and after khat chewing.

Results: The prevalence of khat chewing in this study was found to be 30.6%. Significantly high number of males (60.13%) more than females, Muslims (77.12%) more than Christians, Oromos (64.71%) more than other ethnic groups, literates (72.88%) more than illiterates, were found to be khat chewers. The prevalence of hypertension was found to be10.20% (n=102), tachycardia17.40% (n=174) and that of asthmatics was 18.70%(n=187). Khat chewing habit, frequency of chewing, amount of khat chewing in terms of cost, coffee drinking and age showed significant association (p < 0.001) with blood pressure parameters and heart rate. Heart rate, systolic and diastolic pressures were increased significantly (p < 0.001) after 1 and 2 hours of khat chewing.

Conclusion: There is a significant association (p < 0.001) between khat chewing and blood pressure parameters and heart rate. Gender, religion, age, ethnicity, educational level, smoking and coffee drinking showed strong association with the habit of khat chewing. Regular and chronic khat chewing significantly affects the cardiovascular system. [Ethiop.J.Health Dev. 2002;16(3):325-334]

High-risk sexual behavior and pattern of condom utilization of the Gondar Collage of Medical Sciences (GCMS) Students, North-west Ethiopia

Yohannis Fitaw, Alemayehu Worku

Abstract

Human Immuno Deficiency Virus/Acquired Immuno Deficiency Syndrome (HIV/AIDS) is unique in its devastating impact on the social, economic and demographic development. This study was conducted to assess College students' `knowledge' about condom distribution, high-risk behavior and pattern of condom utilization. A cross-sectional study was done among 383 students of GCMS. Data were collected using a pre-tested self-administered questionnaire. Out of 383 students 214 (56.1%) were sexually active. Among the sexually active students, 37.1% reported ever use of condom. Consistent condom use was reported only by 6.4%. Sexual contact with commercial sex workers was reported by 7.8% of them. Consistent use of condom regardless of partner characteristics should be encouraged among students. [Ethiop.J.Health Dev. 2002;16(3):335-338]