Redda Tekle Haimanot

Community-Based Study of Neurological Disorders in Rural Central Ethiopia

Between 1986 and 1988 a door-to-door survey was conducted on a stable rural population of 60,820 in central Ethiopia. Trained lay health workers made a complete census and identified cases with symptoms and signs of neurological disorders, using specially designed questionnaires which, in a previous pilot study, were found to have a sensitivity of 91% and specificity of 85%. Neurological disorders in the rural population were epilepsy, postpoliomyelitis paralysis, mental retardation, peripheral neuropathy (mainly due to leprosy), and deaf-mutism with prevalence rates (cases/100,000 population) of 520, 240, 170, 150 and 130, respectively. The prevalence rates of the other less common neurological disorders were 62 for hemiparesis (15 of which were for cerebrovascular accidents), 20 for cerebral palsy, 16 for optic atrophy, 12 for perceptive deafness, 10 for tropical spastic paraparesis, 7 for Parkinsons disease and 5 for motor neuron disease, ataxia and chorea/athetosis. Among related non-neurological conditions, blindness, locomotor disability and deafness were predominant. The significance and role of such a neuroepidemiological study in laying the strategies for the prevention of neurological disorders and rehabilitation of patients are discussed in the context of a developing country.

Distribution of fluoride and fluorosis in Ethiopia and prospects for control

Summary A review and mapping of fluoride test data for 270 water sources in 126 communities and examination of the literature of fluorosis distribution in Ethiopia show that this health problem extends beyond the Rift Valley into some highland communities. Fluoride concentrations above 5.0 mg/l in the Rift Valley were found mostly in hot springs (100% of all sources), lakes (78%), shallow wells (54%) and boreholes (35%) and the lowest concentrations (below 1.5 mg/l) in springs and rivers. Analysis of hydrochemical, economic and demographic factors in the spatial distribution of high‐fluoride domestic water sources indicates that the fluorosis problem has become more serious in the Rift Valley in recent decades. Considerable spatial variation in the occurrence of fluoride, even within the same communities, and the presence of some low‐fluoride water sources in the Rift Valley offer possibilities for geochemical exploration for acceptable domestic sources. The defluoridation programme in the Wonji irrigation scheme illustrates the problems faced by a large rural community in a developing country. Possibilities for control are examined and recommendations made for the development of alternative water sources and promising defluoridation methods using locally available materials and technologies.

The Global Campaign (GC) to Reduce the Burden of Headache Worldwide. The International Team for Specialist Education (ITSE)

The social perception of headache, everywhere at low levels in industrialised countries, becomes totally absent in developing ones. Headache disorders came into the World Health Organization’s strategic priorities after publication of the 2001 World Health Report. Among the leading causes of disability, migraine was ranked 19th for adults of both sexes together and 12th for females. The Global Campaign (GC) to Reduce the Burden of Headache Worldwide was planned by the major international headache organizations together with WHO in order to identify and remove those cultural, social and educational barriers recognised as responsible factors for the inadequate treatment of headache disorders worldwide. Within the GC activities, the education of the medical body will represents a central pillar. An International Team for Specialist Education (ITSE) has been created to train physicians from all over the world through the acquisition of a university level Master Degree in Headache Medicine. Once trained as headache specialists, physicians will become trainers, offering education in this field to other health care providers in their own countries. In this way they will give life to a cultural chain raising awareness locally of headache, its burden and its medical control.

Prevalence and burden of primary headache in Akaki textile mill workers, Ethiopia

Headache disorders are the most common complaints worldwide. Migraine, tension-type and cluster headaches account for majority of primary headaches and impose a substantial burden on the individual, family or society at large. The burden is immense on workers, women and children in terms of missing work and school days. There are few studies that show relatively lower prevalence of primary headaches in Africa as compared to Europe and America. There might be many reasons for this lower prevalence. The objective of this study is to determine the prevalence and burden of primary headaches among the Akaki textile factory workers, which may provide data for the local and international level toward the campaign of lifting the burden of headache worldwide. The overall 1-year prevalence of all types of primary headaches was found to be 16.4%, and that of migraine was 6.2%. The prevalence of migraine in females was 10.1% while it was 3.7% in males. The prevalence of tension-type headaches was found to be 9.8%. This was 16.3 % in females as compared to 5.7% in males. The burden of the primary headaches in terms of lost workdays, gross under recognition and absence of effective treatment is tremendous. In conclusion, the prevalence of primary headaches in the Akaki textile mill workers is significant, particularly in females, and the burden is massive, in a place of poverty and ignorance. We recommend the availability and administration of specific therapy to the factory workers with primary headaches, and community based well-designed study for the whole nation’s rural and urban population.

Burden of headache in Africa

Abstract Information on the prevalence and health burden of headache in Africa is scanty. Earlier studies in the 1970s suggested that migraine was a rare condition in the African. This may have been due to an underdiagnosis because in less educated and rural African communities headache is considered a relatively trivial condition compared to other more basic and demanding socio-economic problems. More recent community-based studies put the prevalence rates of migraine between 3%–6.9%. The one-year prevalence of chronic tension-type headache in one African study was 1.7%. A review of the published literature reveal that cluster headache is extremely rare in the African. The clinical features of migraine in the African are similar to those described among Caucasians. However classical migraine appears to be rare in the African. Hot climate particularly exposure to the sun and physical and emotional stress were found to be the most common trigger factor for migraine attacks. Few African migraineurs use specific medications. The majority opt for traditional and herbal therapies. It is to be emphasized that there is a big need to undertake well planned epidemiological studies on headache in African populations using the International Headache Society Criteria with particular emphasis on health facility utilization and sickness absence from work.

Low HTLV-1 seroprevalence in endemic tropical spastic paraparesis in Ethiopia

Tropical spastic paraparesis (TSP), a chronic progressive myelopathy, occurs in Ethiopia in epidemic form as neurolathyrism, while the endemic form has remained obscure. We describe the clinical features of 22 patients with TSP and the results of screening for HTLV-1 in these patients, 26 patients with other neurological disorders, 14 patients with leukaemia and 66 blood donors. The major manifestations in the patients with TSP were weakness and spasticity of the lower limbs with upper motor neurone signs and minimal sensory loss and bladder dysfunction. Two patients with TSP (9%), 2 patients with other neurological disorders (7.7%) and one patient with leukaemia and deafness were seropositive for HTLV-1. All the 66 blood donors were seronegative. Our results suggest that HTLV-1 may not play a major role in the pathogenesis of TSP in Ethiopia.

Altered State of Consciousness in Adult Ethiopians: Analysis of Aetiological Factors

A PROSPECTIVE STUDY to determine the rela tive incidence of diseases causing altered state of consciousness in patients admitted to the medi cal wards of the Tikur Anbessa University Teaching Hospital, Addis Ababa, Ethiopia was undertaken. 300 consecutive patients with altered state of consciousness were included in the study. The majority of patients were below 40 years of age. The causes for altered state of consciousness were metabolic in 125 (41.7%), infectious in 101 (33.7%) and neurological diseases in 64 (21.3%) patients. Hepatic encephalopathy, found in 74 patients (24.7%) was by far the commonest medical cause of altered state of consciousness. In 10 patients (3.3%) no definite diagnosis could be reached. 173 (57.7%) patients died. The age and disease patterns were found to be different from those seen in Europe and North America.