Evaluation of clinical pallor in the identification and treatment of children with moderate and severe anaemia. (25/1130)

BACKGROUND: Anaemia from malaria is a common problem in developing countries. Blood transfusion in developing countries is available in few hospitals. Children who are severely anaemic and may require urgent blood transfusion usually present to peripheral first-level health facilities from where they must be referred to hospitals. Since most peripheral facilities do not determine haemoglobin levels, the decision on referral has to be made on clinical grounds. OBJECTIVES: To evaluate the sensitivity and specificity of clinical pallor of the palms, nailbeds, conjunctivae, buccal mucosa or tongue against haemoglobin values and their reproducibility among health workers. METHODS: A total of 2540 children 2 months to 5 years of age presenting to a rural health centre in Ethiopia were enrolled. Clinically detected pallor was compared with measured blood haemoglobin concentrations. RESULTS: Any anaemia (haemoglobin < 11 g/dl) was found in 61% of the children. Severe anaemia (haemoglobin < 5 g/dl) was found in 4%. The presence of any pallor clinically correlated with moderate anaemia (haemoglobin level < 8 g/dl) could be detected with a sensitivity of 95% and a specificity of 64-68% when the palm and nailbeds were used and a sensitivity of 84% and a specificity of 81% when the conjunctivae were used. Severe anaemia was detected clinically as severe pallor in 50-56% of cases (with a specificity of 95-96%). Agreement between physicians was highest for conjunctivae and nailbed pallor (87%) and lowest for palm pallor (73%). Using multivariate analysis, identification of a systolic ejection murmur or altered sensorium, the presence of splenomegaly or malarial parasitaemia were independently predictive of severe and moderately severe anaemia. CONCLUSIONS: Moderate and severe anaemia can be identified clinically in most cases for treatment and referral purposes. A systolic ejection murmur, altered sensorium, the presence of splenomegaly or malarial parasitaemia may be used as additional tools in considering urgent referral for blood transfusion.  (+info)

The cost of integrating hepatitis B virus vaccine into national immunization programmes: a case study from Addis Ababa. (26/1130)

National programmes of hepatitis B virus (HBV) vaccination are recommended by the World Health Organization for all countries. Countries suffering the highest burden of HBV disease are those most needy of universal vaccination, but are frequently of very low income and resources for health care are scarce. The introduction of HBV vaccination would inevitably stretch these resources further even with support of donor agencies. Thus an assessment of the cost-effectiveness of HBV vaccination is desirable to assist in decision making about resource allocation. We describe here a method for estimating the additional costs of introducing HBV vaccination into the Expanded Programme on Immunization (EPI) at a national level. Of fundamental importance is that this method enables costs to be assessed prior to the introduction of vaccination. We illustrate the method using a study carried out at the sub-national level, in the city of Addis Ababa, Ethiopia, but which can be expanded countrywide. The method, in brief, involved the use of a number of questionnaires which could be used to estimate the costs associated with the EPI programme from a large sample of the static clinics as well as from central sources. Since unit costs were collected along with the quantities of resources used and estimates of the capacity used for certain facilities (such as refrigerators), the additional cost of introducing HBV vaccine could be estimated largely by extrapolation of the resources used in vaccinating against diphtheria/pertussis/tetanus vaccine (which, similar to HBV vaccine, requires three doses). The estimation of costs is only part of the information required to make decisions on resource allocation, and should be used in association with measures of the burden of disease due to the infection in the community and effectiveness of the control programme at reducing this burden. The prediction of the latter, based upon a sound epidemiological understanding of the infection, is the subject of a forthcoming paper.  (+info)

Digital imaging of bone and tooth modification. (27/1130)

Digital cameras are capable of producing images of cut marks and other three dimensional subjects comparable to those obtained from the scanning electron microscope (SEM). Until now, the SEM has offered unparalleled depth of field and surface rendition. SEM units are, however, expensive to acquire and maintain, and SEM image production is time-intensive. Furthermore, SEM images lack color and are often incapable of imaging bone modifications because of magnification and chamber size limitations. A digital imaging method for producing extremely high depth of field enlargements of three dimensional, sub-millimeter scale objects circumvents these problems. In our presentation we employ four case studies of hard tissue modification related to: (1) the origins of meat-eating in the human lineage; (2) evidence for cannibalistic behavior among Neanderthals; (3) pre-Columbian evidence of North American dentistry; and (4) the earliest evidence of cranial surgery in North America. Procedures for replica production, image-capture, and image enhancement are provided. The digital images produced are compared to those obtained with the SEM. Image processing software, a crucial component of this method, allows complete control of graphic data, making graphic fraud a larger threat than ever before. Issues in ethics stemming from the application of this technology to scientific analysis are considered.  (+info)

Distinctive genetic signatures in the Libyan Jews. (28/1130)

Unlinked autosomal microsatellites in six Jewish and two non-Jewish populations were genotyped, and the relationships among these populations were explored. Based on considerations of clustering, pairwise population differentiation, and genetic distance, we found that the Libyan Jewish group retains genetic signatures distinguishable from those of the other populations, in agreement with some historical records on the relative isolation of this community. Our methods also identified evidence of some similarity between Ethiopian and Yemenite Jews, reflecting possible migration in the Red Sea region. We suggest that high-resolution statistical methods that use individual multilocus genotypes may make it practical to distinguish related populations of extremely recent common ancestry.  (+info)

Mortality during a famine--Gode district, Ethiopia, July 2000. (29/1130)

Recurrent famine has been a major cause of mortality in the Horn of Africa. In Ethiopia, three consecutive years of drought led to widespread loss of livestock, population displacement, and malnutrition, placing an estimated 10 million persons at risk for starvation in 2000. A large proportion of the population of the Gode district in Somali region was displaced in a search for food and food aid (CDC, unpublished data, 2000). From April through July 2000, nongovernmental organizations (NGOs) opened feeding centers in the Gode district. Because no vital statistics or public health surveillance system existed in the district, and no representative mortality or morbidity data were available, during July 2000, CDC, in collaboration with Save the Children U.S., the Office of Foreign Disaster Assistance of the U.S. Agency for International Development, and the United Nations Children's Fund (UNICEF), conducted a mortality survey. This report summarizes the results of this survey, which found persistently high levels of mortality, with measles representing an important cause of mortality in children aged <5 years and 5-14 years. Mass measles vaccination with vitamin A distribution is an important intervention during the acute phase of famines in sub-Saharan Africa.  (+info)

Enhanced development in nature of larval Anopheles arabiensis mosquitoes feeding on maize pollen. (30/1130)

To determine whether pollen produced by maize (Zea m. mays) may contribute to the development of larval Anopheles gambiae complex mosquitoes, the main African vectors of malaria, we correlated duration of larval development, pupation success, and size of the resulting adults with degree of access to this potential nutriment. Maize pollen is abundant during the wet season on the surface of water near maize plantings in a malaria-endemic region of Ethiopia, and larval Anopheles arabiensis readily ingest these particles in nature. Larvae develop to the pupal stage more rapidly, more frequently, and produce larger adults where maize pollen is abundant than do those that have little access to this food. The force of transmission of malaria in sub-Saharan Africa might be reduced if maize plantings were excluded from the immediate vicinity of homes or, perhaps, if pollen of such maize were to express entomotoxins.  (+info)

Distinct immunity in patients with visceral leishmaniasis from that in subclinically infected and drug-cured people: implications for the mechanism underlying drug cure. (31/1130)

Significant levels of IgG3 and IgG4 and high levels of IgG1 leishmania-specific antibody differentiated the immune states in 10 patients with visceral leishmaniasis from those of virtually all 20 drug-cured and 18 subclinically infected subjects, whereas the level of IgG2 antibody was nondiscriminating. The most extreme "subclinically infected" outlier subsequently developed disease. Overall, the immune states in subclinically infected and drug-cured persons were mutually indistinguishable but were readily distinguished from those of patients. These findings may have implications for the immunologic mechanism underlying drug cure in visceral leishmaniasis.  (+info)

Evolutionary history and speciation modes in the cyprinid genus Barbus. (32/1130)

Phylogenetic relationships and evolutionary patterns in the genus Barbus were examined through the analysis of the complete sequences of three mitochondrial genes: ATPases 8 and 6, which overlap slightly, and cytochrome b. This complex genus includes diploid as well as tetraploid and hexaploid species that are distributed throughout the Palaearctic, Ethiopian and Asiatic biogeographical regions. Given that genome duplication is an important evolutionary mechanism in eukaryotes, in the present report we attempt to describe its role in the evolution of the genus Barbus, as well as drawing systematic and phylogenetic conclusions. The phylogenetic results indicated the splitting of the current Barbus genus into five main mitochondrial lineages corresponding to (i) the genus Barbus sensu stricto (tetraploid, which is subdivided into the subgenera Barbus and Luciobarbus), (ii) the hexaploid species, (iii) the Ethiopian tetraploid species, (iv) the African diploid species, and (v) the Asian diploid species. The branching of 'foreign' genera as sister groups of some of these monophyletic assemblages (such as Aulopyge is to Barbus sensu stricto or Varicorhinus is to the hexaploid barbels) demonstrates the polyphyly of the group. Moreover, the relationships between the proposed lineages also show that genome duplication may be considered as a homoplasic character since it must have occurred over at least three independent periods and/or in three independent areas. In relation to the possible saltational evolutionary model for the polyploid species examined here, it was found that, although feasible at the nuclear level, the mitochondrial markers looked at do not appear to have undergone this type of evolution. Rather, they seem to have experienced more or less constant change through time.  (+info)