Extracorporeal treatment for ethylene glycol poisoning: systematic review and recommendations from the EXTRIP workgroup

Ethylene glycol (EG) is metabolized into glycolate and oxalate and may cause metabolic acidemia, neurotoxicity, acute kidney injury (AKI), and death. Historically, treatment of EG toxicity included supportive care, correction of acid-base disturbances and antidotes (ethanol or fomepizole), and extracorporeal treatments (ECTRs), such as hemodialysis. With the wider availability of fomepizole, the indications for ECTRs in EG poisoning are debated. We conducted systematic reviews of the literature following published EXTRIP methods to determine the utility of ECTRs in the management of EG toxicity. The quality of the evidence and the strength of recommendations, either strong ("we recommend") or weak/conditional ("we suggest"), were graded according to the GRADE approach. A total of 226 articles met inclusion criteria. EG was assessed as dialyzable by intermittent hemodialysis (level of evidence = B) as was glycolate (Level of evidence = C). Clinical data were available for analysis on 446 patients, in whom overall mortality was 18.7%. In the subgroup of patients with a glycolate concentration ≤ 12 mmol/L (or anion gap ≤ 28 mmol/L), mortality was 3.6%; in this subgroup, outcomes in patients receiving ECTR were not better than in those who did not receive ECTR. The EXTRIP workgroup made the following recommendations for the use of ECTR in addition to supportive care over supportive care alone in the management of EG poisoning (very low quality of evidence for all recommendations): i) Suggest ECTR if fomepizole is used and EG concentration > 50 mmol/L OR osmol gap > 50; or ii) Recommend ECTR if ethanol is used and EG concentration > 50 mmol/L OR osmol gap > 50; or iii) Recommend ECTR if glycolate concentration is > 12 mmol/L or anion gap > 27 mmol/L; or iv) Suggest ECTR if glycolate concentration 8-12 mmol/L or anion gap 23-27 mmol/L; or v) Recommend ECTR if there are severe clinical features (coma, seizures, or AKI). In most settings, the workgroup recommends using intermittent hemodialysis over other ECTRs. If intermittent hemodialysis is not available, CKRT is recommended over other types of ECTR. Cessation of ECTR is recommended once the anion gap is < 18 mmol/L or suggested if EG concentration is < 4 mmol/L. The dosage of antidotes (fomepizole or ethanol) needs to be adjusted during ECTR.

Contribution of physical factors to handpump borehole functionality in Africa

Handpumps are the main water supply for rural communities across sub-Saharan Africa. However, studies show that >25 % of handpumps are non-functional at any time. We present results from a systematic field study of handpump borehole functionality. The study was designed to investigate the contribution of physical factors to functionality outcomes, including; hydrogeology, borehole configuration, and handpump components. To achieve this, we deconstructed and examined 145 handpump boreholes in Ethiopia, Uganda and Malawi. Pumping tests showed that 19 % of boreholes were located in aquifers with transmissivity below the minimum required to sustain a handpump. Water levels, measured during the dry season, had a complex relationship with borehole configuration and transmissivity. The handpump cylinder was <10 m below the water table at 38 % of sites, which increases the risk of the handpump running dry during intensive use and/or in areas of low transmissivity. The water column was <20 m at 23 % of sites and screens were <10 m long at 29 % of sites and often sub-optimally positioned in the borehole. Borehole depth had no clear relationship with functionality. Using multinomial regression and four functionality categories (functional; unreliable; low yield; unreliable and low yield) as dependant variables, we found that transmissivity is a significant risk factor for the classification of handpump boreholes as low yield. The configuration of the borehole (e.g. cylinder position, screen/casing configuration and water column) is a statistically significant risk factor for the classification of handpump boreholes as unreliable. Handpump components were in poor overall condition but rising main pipes were a particular problem with 53 % of galvanised pipes corroded and 82 % of uPVC pipes damaged, with implications for handpump performance. Our study highlights the importance of; understanding aquifer properties, investing in borehole siting, construction (including supervision) and commissioning, and improving the quality of components and maintenance of handpumps.

Groundwater quality: Global threats, opportunities and realising the potential of groundwater

Groundwater is a critical resource enabling adaptation due to land use change, population growth, environmental degradation, and climate change. It can be a driver of change and adaptation, as well as effectively mitigate impacts brought about by a range of human activities. Groundwater quality is key to assessing groundwater resources and we need to improve our understanding and coverage of groundwater quality threats if we are to use groundwater sustainably to not further burden future generations by limiting resources and/or increasing treatment or abstraction costs. Good groundwater quality is key to progress on a range of Sustainable Development Goals, but achievement of those goals most affected by groundwater contamination is often hindered by of a lack of resources to enable adaptation. A range of threats to groundwater quality exist, both natural and anthropogenic, which may constrain groundwater use. However, groundwater often provides good quality water for a range of purposes and is the most important water resource in many settings. This special issue explores some of the key groundwater quality challenges we face today as well as the opportunities good groundwater quality and treatment solutions bring to enhance safe groundwater use. Legacy anthropogenic contaminants and geogenic contaminants may be well documented in certain places, such as N America, Europe and parts of Asia. However, there is a real issue of data accessibility in some regions, even for more common contaminants. This paucity of information can restrict our understanding and ability to manage and protect groundwater sources. Compared to surface water quality, large scale assessments for groundwater quality are still scarce and often rely on inadequate data sets. Better access to existing data sets and more research is needed on many groundwater quality threats. Identification and quantification of these threats will support the wise use and protection of this subsurface resource, allow society to adequately address future challenges, and help communities realise the full potential of groundwater.

Perceptions and reflections of early graduates of the first emergency medicine residency program in Ethiopia: A qualitative study

Introduction

A bi-institutional partnership between physicians at Addis Ababa University, Ethiopia and the University of Toronto, Canada led the development and implementation of a novel emergency medicine (EM) postgraduate training program at Addis Ababa University (AAU). Subsequently, the first three cohorts of trainees were invited to participate in the evaluation of the curricular components devised and delivered by Toronto EM physicians as part of the Toronto Addis Ababa Academic Collaboration in EM (TAAAC-EM). We sought to characterise the strengths and weaknesses of the curriculum to improve it for future trainee cohorts.

Methods

This curriculum assessment used semi-structured, in-depth individual interviews to evaluate components of the TAAAC-EM program curriculum. Interviews were conducted with a purposive sampling of graduates from the first three cohorts of the TAAAC-EM program.

Results

Twelve participants were interviewed. The following themes were identified; The TAAAC-EM program built a novel EM culture at AAU and shifted teaching from didactic to learner-centered strategies where teachers serve as role models; The curriculum content of the EM resident program, including didactic and practical sessions, was well received by the graduates interviewed; Challenges identified included lack of continuity in training, and difficulties transitioning to practice in a locally nascent field; Participants evaluated the TAAAC-EM program model as very positive overall, and supported replicating the model by expanding within Ethiopia and beyond.

Conclusions

The challenges identified in the program, including lack of continuity of clinical teaching and meeting the local educational resource needs of new graduates, helped inform program adaptations and improvements. TAAAC-EM, currently in its eleventh year, is now focused on transitioning full teaching responsibilities to local faculty and continuing to support a positive EM teaching culture. We believe that this thriving partnership can serve as a model for future north-south and south-south collaborations in postgraduate medical education.

Emergency capacity analysis in Ethiopia: Results of a baseline emergency facility assessment

Introduction

In Ethiopia, the specialty of Emergency Medicine is a relatively new discipline. In the last few decades, policymakers have made Emergency Medicine a priority for improving population health. This study aims to contribute to this strengthening of Emergency Medicine, by conducting the country’s first baseline gap analysis of Emergency Medicine Capacity at the pre-hospital and hospital level in order to help identify needs and areas for intervention.

Methods

This is a cross sectional investigation that utilized a convenience sampling of 22 primary, general and tertiary hospitals. Trained personnel visited the hospitals and conducted 4-hour interviews with hospital administrators and emergency care area personnel. The tool used in the interview was the Columbia University sidHARTe Program Emergency Services Resource Assessment Tool (ESRAT) to evaluate both emergency and trauma capacity in different regions of Ethiopia. The findings of this survey were then compared against two established standards: the World Health Organization’s Essential Package of Emergency Care (EPEC), as well as those set by Ethiopia’s Federal Ministry of Health.

Results

The tool assessed the services provided at each hospital and evaluated the infrastructure of emergency care at the facility. Triage systems differed amongst the hospitals surveyed though triaging and emergency unit infrastructures were relatively similar amongst the hospitals. There was a marked variability in the level of training, guidelines, staffing, disaster preparedness, drug availability, procedures performed, and quality assurance measures from hospital to hospital. Most regional and district hospitals did not have nurses or doctors trained in Emergency Medicine and over 70% of the hospitals did not have written guidelines for standardized emergency care.

Conclusion

This gap analysis has revealed numerous inconsistencies in health care practice, resources, and infrastructure within the scope of Emergency Medicine in Ethiopia. Major gaps were identified, and the results of this assessment were used to devise action priorities for the Ministry of Health. Much remains to be done to strengthen Emergency Medicine in Ethiopia, and numerous opportunities exist to make additional short and long-term improvements.

Maintaining a global health partnership during the COVID-19 pandemic: a road map from the Toronto Addis Ababa Academic Collaboration in Emergency Medicine

The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is an educational global health partnership established 10 years ago to support the growth of EM in Ethiopia. In-person global health partnership activities were disrupted by the COVID-19 pandemic. We describe our five-step process for transitioning our global health partnership to a virtual space. Each step was conducted in collaboration between the University of Toronto and Addis Ababa University EM physicians: (1) risk identification and needs assessment, (2) discussing mitigation strategies, (3) crafting and piloting an approach, (4) revising based on pilot results, 5) implementation with continuous evaluation and revision. Teaching was modified iteratively in response to feedback. Our experience shows that virtual teaching, while not a replacement for in-person engagement, can be a valuable tool both to supplement partnership activities when travel is not possible, and to enhance global health partnerships long term. This approach can also inform the transition of other forms of medical education to the virtual space.

Knowledge of Risk Factors and Warning Signs of Stroke Among Patients with Heart Disease at Tikur Anbessa Specialized Hospital

BACKGROUND

Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are extensive. The inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention and which leads to secondary complications.

PURPOSE

To identify cardiac patients' knowledge of stroke risk factors and warning signs.

PATIENTS AND METHODS

The institutional based cross-sectional study design was employed. Participants were selected using systematic random sampling. Close-ended questionnaires were pre-tested and validated for consistency before data collection. Then after data collection, data were checked and entered into Epi-data 4.6. Finally, the cleaned data were exported to SPSS version 25 for analysis. Statistical analysis using binary logistic regression was done and Predictors with a p-value of <0.05 were considered statistically significant.

RESULTS

A total of 227 patients were included in the study, of which 140 (61.7%) of them identified physical inactivity, followed by hypertension126 (55.5%) as stroke risk factor while 15.4% of them did not know any risk factor of stroke. Amongst the study participants, 45.81% of them had adequate knowledge of stroke risk factors. Regarding stroke warning signs the most identified sign was sudden unilateral weakness 142 (62.6%) while 46 (20.26%) of them did not know at least one warning sign of a stroke. Based on multivariable logistic regression analysis, higher education level AOR 3.05 (95% CI 1.62-5.74) and Urban residence area AOR 2.07 (95% CI 1.05-4.1) were significantly associated with knowledge of stroke risk factors with p-value<0.05.

CONCLUSION

Study participants had inadequate knowledge of stroke risk factors and warning signs. Educational status and information about stroke are significantly associated with adequate knowledge of stroke risk factors, raising stroke awareness is the mainstay to reduce stroke burden.

Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup

BACKGROUND

Calcium channel blockers (CCBs) are commonly used to treat conditions such as arterial hypertension and supraventricular dysrhythmias. Poisoning from these drugs can lead to severe morbidity and mortality. We aimed to determine the utility of extracorporeal treatments (ECTRs) in the management of CCB poisoning.

METHODS

We conducted systematic reviews of the literature, screened studies, extracted data, summarized findings, and formulated recommendations following published EXTRIP methods.

RESULTS

A total of 83 publications (6 in vitro and 1 animal experiments, 55 case reports or case series, 19 pharmacokinetic studies, 1 cohort study and 1 systematic review) met inclusion criteria regarding the effect of ECTR. Toxicokinetic or pharmacokinetic data were available on 210 patients (including 32 for amlodipine, 20 for diltiazem, and 52 for verapamil). Regardless of the ECTR used, amlodipine, bepridil, diltiazem, felodipine, isradipine, mibefradil, nifedipine, nisoldipine, and verapamil were considered not dialyzable, with variable levels of evidence, while no dialyzability grading was possible for nicardipine and nitrendipine. Data were available for clinical analysis on 78 CCB poisoned patients (including 32 patients for amlodipine, 16 for diltiazem, and 23 for verapamil). Standard care (including high dose insulin euglycemic therapy) was not systematically administered. Clinical data did not suggest an improvement in outcomes with ECTR. Consequently, the EXTRIP workgroup recommends against using ECTR in addition to standard care for patients severely poisoned with either amlodipine, diltiazem or verapamil (strong recommendations, very low quality of the evidence (1D)). There were insufficient clinical data to draft recommendation for other CCBs, although the workgroup acknowledged the low dialyzability from, and lack of biological plausibility for, ECTR.

CONCLUSIONS

Both dialyzability and clinical data do not support a clinical benefit from ECTRs for CCB poisoning. The EXTRIP workgroup recommends against using extracorporeal methods to enhance the elimination of amlodipine, diltiazem, and verapamil in patients with severe poisoning.

Utilization of personal protective equipment and associated factors among building construction workers in Addis Ababa, Ethiopia, 2019

BACKGROUND

Personal protective equipment (PPE) is a material, device, equipment, or clothing used or worn by workers to reduce their chance of exposure or contact with any harmful material or energy that causes injury, disease, or even death. The use of PPE is a universal legal requirement to reduce occupational injuries and illnesses in the workplace. Therefore, this study was conducted to assess PPE utilization and its associated factors among building construction workers in Addis Ababa, Ethiopia, 2019.

METHODS

Institution based quantitative cross-sectional study was conducted on the selected construction sites of Addis Ababa city from April 1 to May 18, 2019. Data were collected among all (206) building construction workers via interviewer-administered questionnaires. Data were entered into Epi info version 7.1 and exported to SPSS version 25 statistical software for analysis. Variables with a p-value of less than 0.20 in bivariate analysis were included in multivariate logistic regression. Finally, variables with a p-value of less than 0.05 in multivariate analysis were considered as significantly associated.

RESULTS

The utilization of at least one PPE among building construction workers in Addis Ababa was found to be 38%. The majority (41.1%) of the participants' reason for not using PPE were the unavailability of PPE followed by absence of orientation on using PPE (21.3%). The majority (35.3%) and (32.2%) of participants knew abrasion as a type of injury and suffered from abrasion respectively. Factors associated with utilization of PPE were the presence of training on PPE use (AOR = 4.8; 95% CI: 2.3, 10.3), presence of safety training (AOR = 2,8; 95% CI:1.5, 5.2), safety orientation before commencing work (AOR = 4.0; 95% CI:1.9, 9.0) and presence of supervision (AOR = 5.0; 95% CI:1.9,13).

CONCLUSIONS

PPE utilization among building construction workers in Addis Ababa was low. The main reasons for non-utilization of PPE were unavailability of the materials and the absence of orientation on using PPE. The presence of PPE use training, presence of safety training, safety orientation, and governmental supervision were factors associated with PPE utilization. There should be continuous supervision of construction sites to assure all workers get material and training on how to use it.

Comparative performance of rural water supplies during drought

As rural African communities experience more frequent and extreme droughts, it is increasingly important that water supplies are climate resilient. Using a unique temporal dataset we explore rural water supply (n = 5196) performance during the 2015-16 drought in Ethiopia. Mean functionality ranged from 60% for motorised boreholes to 75% for hand-pumped boreholes. Real-time monitoring and responsive operation and maintenance led to rapid increases in functionality of hand-pumped and, to a lesser extent, motorised boreholes. Increased demand was placed on motorised boreholes in lowland areas as springs, hand-dug-wells and open sources failed. Most users travelled >1 h to access motorised boreholes but <30 min, increasing to 30-60 mins, for hand-pumped boreholes. Boreholes accessing deep (>30 m) groundwater performed best during the drought. Prioritising access to groundwater via multiple improved sources and a portfolio of technologies, such as hand-pumped and motorised boreholes, supported by responsive and proactive operation and maintenance, increases rural water supply resilience.

Prospective assessment of patients with stroke in Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia

Introduction

The burden of stroke is increasing in many low- and middle-income countries. In Ethiopia, stroke has become a major cause of morbidity, long-term disability, and mortality. Time from stroke onset to hospital presentation is a critical factor in acute stroke care. This study aimed to describe risk factors for stroke and clinical presentation of patients presenting to the emergency centre with stroke.

Methods

We conducted a cross sectional study conducted from August 2015 to January 2016 in an urban tertiary care centre in Addis Ababa, Ethiopia. Descriptive statistics and multivariable logistic regression models were used to evaluate associations between stroke types and stroke risk factors, and delayed presentation and clinical indicators. P-values less than .05 were considered statistically significant.

Results

A total of 104 patients were included. The mean age was 53 years, and 56% were male. Only 30% of patients arrived using an ambulance service. The most common presenting symptoms were altered mental status (48%), hemiparesis (47%), facial palsy (45%), hemiplegia (29%), and aphasia (25%). Hypertension was the most common risk factor (49%), followed by cardiovascular disease (20.2%) and diabetes mellitus (11%). The majority of strokes were haemorrhagic in aetiology (56%). The median arrival time to the emergency centre was 24 h after symptoms onset; only 15% presented within three hours. Patients with hypertension, or presented with loss of consciousness were significantly more likely to have haemorrhagic stroke (p < .001 and p = .01 respectively). The only risk factor robustly associated with ischaemic stroke was cardiac illness (odds ratio 3.99, p = .01).

Discussion

Our study identified hypertension to be the most common risk factor for stroke. The predominant aetiology type in this cohort is haemorrhagic stroke. Lastly, the median arrival time to an emergency centre was 24 h after symptom onset.

Improving influenza surveillance in sub-Saharan Africa

PROBLEM

Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations.

APPROACH

A project known as Strengthening Influenza Sentinel Surveillance in Africa (SISA) was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance.

LOCAL SETTING

Influenza surveillance systems in the target countries were in different stages of development when SISA was launched. Senegal, for instance, had conducted virological surveillance for years, whereas Sierra Leone had no surveillance activity at all.

RELEVANT CHANGES

Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organized.

LESSONS LEARNT

Targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership.

Coronary artery fistulae

Coronary artery fistulae are abnormal communications between a coronary artery and a cardiac chamber or major vessel (vena cava, pulmonary veins, pulmonary artery). They are usually diagnosed by coronary arteriography. Clinical presentations are variable depending on the type of fistula, shunt volume, site of the shunt, and presence of other cardiac conditions. In this article, we review the literature regarding etiology, incidence, clinical manifestation, image studies, and management.

Maternal rubella-specific antibody prevalence in Ethiopian infants

In countries with a high transmission rate of rubella the optimal age for universal rubella vaccination of infants is critically dependent upon the rate of loss of maternal antibodies. Few studies have investigated the decay characteristics of such antibodies. Mother:infant pairs were recruited at the Ethio-Swedish Children's Hospital, Addis Ababa, in 1994/95. Rubella antibody levels, determined by radial haemolysis, were available for analysis from 1542 infants aged 0-12 months, with 942 repeat measures, and from 846 mothers. Decay in seropositivity was well described by a delayed exponential function. The proportion seropositive at age 6, 9, or 12 months was 6-13%, 1-4%, or 0-1%, respectively, dependent upon assay cutoff level. Only infant age and mother's antibody level were important predictors of seropositivity. Results suggest that the success of vaccination at age 9 months or above would be little affected by residual maternal antibodies.

A survey of illegal abortion in Jimma Hospital, south western Ethiopia

A cross-sectional descriptive study of induced abortion was conducted in Jimma Hospital, South-western Ethiopia to determine socio-economic factors and associated problems during February 25-May 5, 1996. There were a total of 80 patients with a diagnosis of induced abortion were enrolled of which 50 (62.5%) cases were admitted for bleeding and infections. Thirty six (45%) of all cases were primigravidae. Students accounted for 28 (35%) of the cases. Seventy (87.5%) of the cases could read and write and only 31 (38.8%) were married. Seventy (87.5%) knew presence of family planning methods, and 40 (50%) used at least once previously. Eighteen (22.5%) gave economic problems as reason for abortion, and 76 (95%) of them used either rubber tubes or roots of plants to induce the abortion. Of the total 42 (52.5%) believed that the right of abortion concerns mainly themselves. The study showed that the problem is quite significant in the area. We recommend for a wide scale community based study concerning the problem. A well organized sex education, family planning services and family education are also suggested in order to alleviate the problem.

The effect of timing of sample collection on the detection of measles-specific IgM in serum and oral fluid samples after primary measles vaccination

This study compares the timing of the rise and decline of measles-specific IgM in serum samples and in oral fluid samples. Two hundred and eighty 9-month-old infants presenting for routine measles vaccination in Addis Ababa, Ethiopia, were enrolled. Paired serum and oral fluid samples were collected before and 1, 2, 3 or 4 weeks after measles vaccination. Samples were tested by using a modified antibody-capture enzyme immunoassay. For the 321 IgM-negative pre- and post-vaccination serum samples, 317 (99 %) of their corresponding oral fluid samples were IgM-negative. Among the 130 IgM-positive serum samples, 75% of their paired oral fluid samples were IgM-positive, with the percentage rising to 87% after oral fluid samples collected > or =3.5 weeks after vaccination were excluded. Among the post-vaccination serum samples, the percent IgM-positive peaked in week 3 and declined to 79% in week 4. For post-vaccination oral fluid samples, the percent IgM-positive peaked in weeks 2 and 3, and then declined to 43% in week 4. This modified antibody-capture enzyme immunoassay appears to detect vaccine-induced measles-specific IgM in the first 3 weeks after vaccination.

Etiology of pneumonia, sepsis and meningitis in infants younger than three months of age in Ethiopia

METHODS

Within a multicenter study coordinated by WHO, an investigation of the etiologic agents of pneumonia, sepsis and meningitis was performed among infants younger than 3 months of age seen at the Ethio-Swedish Children's Hospital in Addis Ababa for a period of 2 years. Of the 816 infants enrolled 405 had clinical indications for investigation.

RESULTS

There were a total of 41 isolates from blood cultures from 40 infants. The study showed that the traditionally known acute respiratory infection pathogen Streptococcus pneumoniae was most common in this extended neonatal age group, found in 10 of 41 blood isolates. Streptococcus pyogenes was a common pathogen in this setting (9 of 41 blood isolates), whereas Salmonella group B was found in 5 of 41 isolates. Streptococcus agalactiae, which is a common pathogen in developed countries, was absent. A study of the susceptibility pattern of these organisms suggests that a combination of ampicillin with an aminoglycoside is adequate for initial treatment of these serious bacterial infections, but the combination is not optimal for the treatment of Salmonella infections. Among 202 infants on whom immunofluorescent antibody studies for viruses were performed based on nasopharyngeal aspirates, respiratory syncytial virus was found in 57 (28%) infants, and Chlamydia trachomatis was isolated in 32 (15.8%) of 203 infants.

Timing of development of measles-specific immunoglobulin M and G after primary measles vaccination

A standard method for diagnosing measles is to detect measles-specific immunoglobulin M (IgM) in the serum of infected persons. Interpreting a positive IgM result from a person with suspected measles can be difficult if the person has recently received a measles vaccine. We have previously demonstrated that measles-specific IgM may persist for at least 8 weeks after primary vaccination, but it is unknown how quickly IgM appears. This study determined the timing of the rise of measles-specific IgM and IgG after primary measles vaccination with Schwartz vaccine. Two hundred eighty 9-month-old children from Ethiopia presenting for routine measles vaccination were enrolled. Sera were collected before and either 1, 2, 3, or 4 weeks after vaccination and tested for measles-specific antibodies by an IgM capture enzyme immunoassay (EIA) and by an indirect IgG EIA. A total of 209 of the 224 children who returned for the second visit had prevaccination sera that were both IgM and IgG negative. The postvaccination IgM positivity rates for these 209 children were 2% at 1 week, 61% at 2 weeks, 79% at 3 weeks, and 60% at 4 weeks. The postvaccination IgG positivity rates were 0% at 1 week, 14% at 2 weeks, 81% at 3 weeks, and 85% at 4 weeks. We conclude that an IgM-positive result obtained by this antibody capture EIA is difficult to interpret if serum is collected between 8 days and 8 weeks after vaccination; in this situation, the diagnosis of measles should be based on an epidemiologic linkage to a confirmed case or on the detection of wild-type measles virus.

Comparative detection of measles-specific IgM in oral fluid and serum from children by an antibody-capture IgM EIA

In vaccinated populations, the diagnosis of measles often requires laboratory confirmation. Serum tested by EIAs has proven sensitive and specific for diagnosing measles. For comparison of detection of measles-specific IgM in oral fluid and serum samples by an antibody-capture EIA, 163 Ethiopian infants who presented for routine measles vaccination were studied. Paired serum and oral fluid samples were collected before and 2 weeks after vaccination; 269 paired samples were adequate for analyses. Of the 104 serum samples that were IgM-positive, 95 (91%) of the paired oral fluid samples were IgM-positive. Of the 165 serum samples that were IgM-negative, 156 (95%) of the paired oral fluid samples were IgM-negative. The Pearson partial correlation coefficient for optical density readings from postvaccination oral fluid compared with serum was 0.81. Oral fluid appears to be an acceptable alternative to serum for measuring measles-specific IgM antibodies by an antibody-capture EIA.

Sociodemographic profile of children affected by AIDS in Addis Abeba

A survey was conducted in Addis Abeba between October 2, 1993 and December 10, 1993 to assess orphanhood due to AIDS deaths. It was possible to trace only 1,047 AIDS cases among residents of Addis Abeba. During the survey, 59% of the cases and 16% of their spouses were already dead. The total number of children born to the index cases were 2186, among which, 883 (40.4%) were below 15 years of age. Two hundred eighty (30.4%) of these children had lost either one or both parents. Other social problems include ill health in 10.5% among which 3.9% had AIDS; 14.1% were school dropouts. There were also children who faced abandonment, displacement and who lacked medical care at the time of their illness. The existing coping mechanism seems to be relying on the extended family, which is an important social support system. However, there is a need to raise community awareness and strengthen the system to enhance the effort in protecting and supporting children affected by AIDS.

Status of expanded program on immunization in a rural town--south Ethiopia

A community based cross-sectional survey was conducted in a randomly selected kebele of Zway town, eastern Shoa, Kilil 4, to assess the status of expanded program of immunization. A total of 309 children aged 12-23 months were entered into the study. Fifty-three per cent of the children were fully immunized, 19% were defaulters and the rest were totally not immunized. The main reason for defaulting were inconvenience of vaccination time, child sickness and lack of information about the need for repeated vaccination. The main reasons for not being immunized were lack of faith in vaccination, not knowing its availability and lack of time. Inconsistent outreach programs and weak health education were the major rectifiable causes of the low coverage and high defaulter rate. Strengthening of the health education and outreach programs and development of mechanism for follow-up and defaulter tracing are recommended.