Tag Archives: Ethiopia

Childhood diarrhea in West Gojjam, Northwest Ethiopia

Girma M, Gobena T, Medhin G, Gasana J, Roba KT. Determinants of childhood diarrhea in West Gojjam, Northwest Ethiopia: a case control study. The Pan African medical journal. 2018 Jul 27;30:234. doi: 10.11604/pamj.2018.30.234.14109.

INTRODUCTION: Childhood diarrhea is a global public health problem that affects both developed and developing countries including Ethiopia. The objective of this study was to assess determinants of childhood diarrhea among children under-five years of age in West Gojjam Zone, northwest Ethiopia.

METHODS: A community-based case control study was conducted in four districts of West Gojjam in the northwest of Ethiopia from July to August, 2015. A randomly selected sample of 118 cases and 351 controls who met the inclusion criteria were included in this study. Data were collected using a structured questionnaire through face to face interview. Independent variables which had p-value less than 0.2 at an unadjusted model were candidate for the final model. Adjusted odds ratio was used to control confounding effects and to determine predictors of an outcome.

RESULTS: Unimproved water sources (AOR, 1.88; 95 % CI: 1.17-3.03), lack of hand washing at critical times (AOR, 2.38; 95 % CI: 1.42-3.99) and a deepening method to take water from a water storage container (AOR, 2.11; 95 % CI: 1.28-3.47), presence of two or more young siblings (AOR, 4.15; 95 % CI: 2.57-6.70), rural residence (AOR,2.11 95 % CI: 2.21-3.68), and not using latrine for disposal of child feces (AOR, 1.90; 95 % CI: 1.12-3.22) were predictors of diarrhea among children under the age of five.

CONCLUSION: The majority of the causes of childhood diarrhea in the study area were preventable. Thus, health extension workers should give tailored health information to mothers or caregivers on the importance of sanitation, personal and environmental hygiene and drinking water handling methods.

Childhood Diarrhea Prevalent in Nomadic Community, Ethiopia

Bitew BD, Woldu W, Gizaw Z. Childhood diarrheal morbidity and sanitation predictors in a nomadic community. Ital J Pediatr. 2017 Oct 6;43(1):91. doi: 10.1186/s13052-017-0412-6.

BACKGROUND: Diarrhea remains a leading killer of young children on the globe despite the availability of simple and effective solutions to prevent and control it. The disease is more prevalent among under – five children (U5C) in the developing world due to lack of sanitation. A child dies every 15 s from diarrheal disease caused largely by poor sanitation. Nearly 90% of diarrheal disease is attributed to inadequate sanitation. Even though, the health burden of diarrheal disease is widely recognized at global level, its prevalence and sanitation predictors among a nomadic population of Ethiopia are not researched. This study was therefore designed to assess the prevalence of childhood diarrheal disease and sanitation predictors among a nomadic people in Hadaleala district, Afar region, Northeast Ethiopia.

METHODS: A community based cross-sectional study design was carried out to investigate diarrheal disease among U5C. A total of 704 households who had U5C were included in this study and the study subjects were recruited by a multistage cluster sampling technique. Data were collected using a structured questionnaire and an observational checklist. All the mothers of U5C found in the selected clusters were interviewed. Furthermore, the living environment was observed. Univariable binary logistic regression analysis was used to choose variables for the multivariable binary logistic regression analysis on the basis of p- value less than 0.2. Finally, multivariable binary logistic regression analysis was used to identify variables associated with childhood diarrhea disease on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05.

RESULTS: The two weeks period prevalence of diarrheal disease among U5C in Hadaleala district was 26.1% (95% CI: 22.9 – 29.3%). Childhood diarrheal disease was statistically associated with unprotected drinking water sources [AOR = 2.449, 95% CI = (1.264, 4.744)], inadequate drinking water service level [AOR = 1.535, 95% CI = (1.004, 2.346)], drinking water sources not protected from animal contact [AOR = 4.403, 95% CI = (2.424, 7.999)], un-availability of any type of latrine [AOR = 2.278, 95% CI = (1.045, 4.965)], presence of human excreta in the compound [AOR = 11.391, 95% CI = (2.100, 61.787)], not washing hand after visiting toilet [AOR = 16.511, 95% CI = (3.304, 82.509)], and live in one living room [AOR = 5.827, 95% CI = (3.208, 10.581)].

CONCLUSION: Childhood diarrheal disease was the common public health problem in Hadaleala district. Compared with the national and regional prevalence of childhood diarrhea, higher prevalence of diarrhea among U5C was reported. Types of drinking water sources, households whose water sources are shared with livestock, volume of daily water collected, availability of latrine, presence of faeces in the compound, hand washing after visiting the toilet and number of rooms were the sanitation predictors associated with childhood diarrhea. Therefore, enabling the community with safe and continuous supply of water and proper disposal of wastes including excreta is necessary with particular emphasis to the rural nomadic communities.

Skeletal and Dental Fluorosis in Rural Ethiopian Children

Kebede A, Retta N, Abuye C, Whiting SJ, Kassaw M, Zeru T, Tessema M, Kjellevold M. Dietary Fluoride Intake and Associated Skeletal and Dental Fluorosis in School Age Children in Rural Ethiopian Rift Valley. International journal of environmental research and public health. 2016 Jul 26;13(8). pii: E756. doi: 10.3390/ijerph13080756.

An observational study was conducted to determine dietary fluoride intake, diet, and prevalence of dental and skeletal fluorosis of school age children in three fluorosis endemic districts of the Ethiopian Rift Valley having similar concentrations of fluoride (F) in drinking water (~5 mg F/L). The duplicate plate method was used to collect foods consumed by children over 24 h from 20 households in each community (n = 60) and the foods, along with water and beverages, were analyzed for fluoride (F) content. Prevalence of dental and skeletal fluorosis was determined using presence of clinical symptoms in children (n = 220). Daily dietary fluoride intake was at or above tolerable upper intake level (UL) of 10 mg F/day and the dietary sources (water, prepared food and beverages) all contributed to the daily fluoride burden. Urinary fluoride in children from Fentale and Adamitulu was almost twice (>5 mg/L) the concentration found in urine from children from Alaba, where rain water harvesting was most common. Severe and moderate dental fluorosis was found in Alaba and Adamitulu, the highest severity and prevalence being in the latter district where staple foods were lowest in calcium. Children in all three areas showed evidence of both skeletal and non-skeletal fluorosis. Our data support the hypothesis that intake of calcium rich foods in addition to using rain water for household consumption and preparation of food, may help in reducing risk of fluorosis in Ethiopia, but prospective studies are needed.

Urinary fluoride and children’s dental fluorosis – Ethiopia

Rango T, Vengosh A, Jeuland M, Tekle-Haimanot R, Weinthal E, Kravchenko J, Paul C, McCornick P. Fluoride exposure from groundwater as reflected by urinary fluoride and children’s dental fluorosis in the Main Ethiopian Rift Valley. Sci Total Environ. 2014 Jul 29;496C:188-197. doi: 10.1016/j.scitotenv.2014.07.048.

This cross-sectional study explores the relationships between children’s F- exposure from drinking groundwater and urinary F- concentrations, combined with dental fluorosis (DF) in the Main Ethiopian Rift (MER) Valley. We examined the DF prevalence and severity among 491 children (10 to 15years old) who are life-long residents of 33 rural communities in which groundwater concentrations of F- cover a wide range. A subset of 156 children was selected for urinary F- measurements. Our results showed that the mean F- concentrations in groundwater were 8.5±4.1mg/L (range: 1.1-18mg/L), while those in urine were 12.1±7.3mg/L (range: 1.1-39.8mg/L). The prevalence of mild, moderate, and severe DF in children’s teeth was 17%, 29%, and 45%, respectively, and the majority (90%; n=140) of the children had urinary F- concentrations above 3mg/L. Below this level most of the teeth showed mild forms of DF. The exposure-response relationship between F- and DF was positive and non-linear, with DF severity tending to level off above a F- threshold of ~6mg/L, most likely due to the fact that at ~6mg/L the enamel is damaged as much as it can be clinically observed in most children. We also observed differential prevalence (and severity) of DF and urinary concentration, across children exposed to similar F- concentrations in water, which highlights the importance of individual-specific factors in addition to the F- levels in drinking water. Finally, we investigated urinary F- in children from communities where defluoridation remediation was taking place. The lower F- concentration measured in urine of this population demonstrates the capacity of the urinary F- method as an effective monitoring and evaluation tool for assessing the outcome of successful F- mitigation strategy in relatively short time (months) in areas affected with severe fluorosis.

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Fluoride removal in rural Ethiopia

Osterwalder L, Johnson CA, Yang H, Johnston RB. Multi-criteria assessment of community-based fluoride-removal technologies for rural Ethiopia. Sci Total Environ. 2013 Nov 14. pii: S0048-9697(13)01216-3. doi: 10.1016/j.scitotenv.2013.10.072.

Elevated concentrations of naturally-occurring fluoride in groundwater pose a serious health risk to millions of people living in the Ethiopian Rift Valley. In the absence of low-fluoride water resources of sufficient capacity, fluoride removal from drinking water is the accepted mitigation option. To date, five different community-level fluoride-removal technologies have been implemented in Ethiopia, although only a few units have been found in a functional state in the field. Which technology should be promoted and up-scaled is the subject of controversial debate amongst key stakeholders. This paper describes a multi-criteria decision analysis exercise, which was conducted with the participation of stakeholders in Ethiopia during a one-day workshop, to assess in an objective and transparent manner the available technology options. Criteria for technology comparison were selected and weighted, thus enabling the participants to assess the advantages and disadvantages of the different technologies and hear the views of other stakeholders. It was shown that there is no single most-preferable, technical solution for fluoride removal in Ethiopia. Selection of the most suitable solution depends on location-specific parameters and on the relative importance given to different criteria by the stakeholders involved. The data presented in this paper can be used as reference values for Ethiopia.

Substance flow analysis assess total fluoride intake…

Malde, M.K., Scheidegger, R., Julshamn, K., Bader, H.-P. Substance Flow Analysis: A Case Study of Fluoride Exposure through Food and Beverages in Young Children Living in Ethiopia. Environmental Health Perspectives; Apr2011, Vol. 119 Issue 4, p579-584.

Dental and skeletal fluorosis is endemic in the Ethiopian Rift Valley. Children are especially vulnerable to excessive fluoride intake because their permanent teeth are still being formed. Strategies to reduce the total fluoride intake by children are thus warranted. CASE PRESENTATION: By combining the results of field studies in Ethiopia, the relevant pathways for fluoride intake have been identified in 28 children 2-5 years of age living in two villages on the Wonji Shoa Sugar Estate in the Ethiopian Rift Valley. The focus of the present study was to simulate the fluoride intake of the children using the methods of material flow analysis (MFA) and substance flow analysis. DISCUSSION: With a model based on MFA, we quantified the potential reduction in total fluoride intake given different scenarios–for example, by reducing the fluoride intake from drinking water and cooking water. The results show clearly that only by removing fluoride completely from both drinking and cooking water does the probability of remaining below the daily tolerable upper intake level exceed 50%. Both prepared food and food ingredients must be taken into consideration when assessing the total fluoride intake by children living in high-fluoride areas. RELEVANCE: This knowledge will help health personnel, the government, and the food authorities to give scientifically based advice on strategies for reducing the total fluoride intake by children living in high-fluoride areas in the Ethiopian Rift Valley.