Sandro Accorsi

'Killer' canines : the morbidity and mortality of ebino in northern Uganda

Summary In northern Uganda, unerupted primary canine teeth are commonly extracted because they are believed to cause diarrhoea, vomiting, and fever. This practice, known as ebino, is performed under very crude conditions often using unclean tools. To evaluate the morbidity and mortality of complications related to ebino, we retrospectively analysed discharge records from the paediatric ward of Lacor Hospital, Gulu. In the period 1992–98, ebino‐related complications, mainly sepsis and anaemia, were among the leading causes of admission (n = 740) and hospital death (n = 156, case fatality rate = 21.1%, proportional mortality rate = 3.3%). Discouraging the adoption of deeply rooted traditional practices that are potentially hazardous to health should be a public health priority in northern Uganda. This could be done by educating not only the general public, but also traditional healers and community and religious leaders, who could convey the knowledge to their people.

Trend in HIV-1 prevalence in an antenatal clinic in North Uganda and adjusted rates for the general female population

ObjectivesTo estimate HIV-1 prevalence among women attending an antenatal clinic in the Gulu District (North Uganda) and, based on these data, among the districts female population. MethodsAnonymous HIV-1 screening was performed for 8555 antenatal clinic attendees aged 15–39 years in the period 1993–1997. The results were used to estimate the prevalence among the districts female population, accounting for differences in fertility rates by HIV-1 serostatus. ResultsAmong antenatal clinic attendees, HIV-1 prevalence showed a significant linear decrease (P < 0.001), from 26.0% in 1993 [95% confidence Interval (CI), 23.2–29.0%] to 16.1% in 1997 (95% CI, 14.8–17.5%). This decrease was mostly due to a marked decrease until 1995 (14.3%; 95% CI, 12.7–16.0%) and was more pronounced among women aged under 30 years (P < 0.001), from both urban and rural areas (P < 0.001). The risk of being infected was higher among women from urban areas (Gulu Municipality), both over the entire period (adjusted prevalence proportion ratio = 1.54; 95% CI, 1.40–1.68) and by individual year. The estimated prevalence for the 15–39-year-old female population, standardized by age and area of residence, decreased from 25.4% in 1993–1994 to 17.8% in 1996–1997; these rates were 1.22 and 1.28 times higher, respectively, than those among antenatal clinic attendees. ConclusionsThe trend of decrease among young women, for whom changes in HIV-1 prevalence more closely reflect incidence, could be partially due to a reduction in risk behaviour and a consequent decreasing incidence. Differences in fertility rates by HIV-1 serostatus should be addressed when using antenatal clinic data to estimate prevalence among the general female population.

Estimating HIV prevalence and the impact of HIV/AIDS on a Ugandan hospital by combining serosurvey data and hospital discharge records.

Objective To estimate the disease-specific HIV prevalence in a northern Ugandan hospital and to evaluate the impact of HIV/AIDS on hospital services. Design HIV serosurvey and analysis of routinely compiled hospital records. Methods The serosurvey was conducted among all 352 patients admitted to the medical ward of the Lacor Hospital in March 1999 (this ward consists of 3 units: general medicine, tuberculosis, and cancer). The impact on hospital services was estimated using the hospital discharge records for all 3447 patients admitted in 1999, in combination with serosurvey data, and was expressed as the percentage of bed-days attributable to HIV-positive patients. Results The overall HIV prevalence was 42.0% (52.6, 44.6, and 13.2% in the general medicine, tuberculosis, and cancer units, respectively). The disease-specific prevalence ranged from 45–65% for patients with tuberculosis, pneumonia, malaria, and enteritis. HIV-positive patients, compared with HIV-negative patients, had a higher in-hospital mortality (14.6 vs. 3.0%) and a lower average length of stay (41.4 vs. 48.9 days). AIDS cases accounted for 5.0% of hospital admissions, 4.1% of bed-days, and 11.5% of deaths. When considering all HIV-positive patients, these accounted for 37.2% of the bed-days. Conclusions Knowledge of disease-specific HIV prevalence and of the patterns of HIV-related diseases is crucial for early case management. The impact of HIV-positive patients on hospital services is quite high, accounting for >1/3 of the bed-days in 1999. Providing a continuum of care through inpatient, outpatient, and outreach home care services probably represents the only means of relieving the pressure on overloaded hospitals.

Countdown to 2015: comparing progress towards the achievement of the health Millennium Development Goals in Ethiopia and other sub-Saharan African countries.

Mid-way 2007 reports indicate that many low-income countries, at current rates of progress, are unlikely to reach the Millennium Development Goals (MDG) by 2015. In Ethiopia, a decline was observed in under-five mortality rates from 204 to 123 per 1000 live births between 1990 and 2005, showing good progress towards the achievement of MDG4. A downward trend was observed in the maternal mortality ratio; however, because of the high degree of sampling variability, it is not possible to reach any firm conclusion about the possibility of achieving MDG5. Regarding MDG6, good progress was observed in controlling HIV/AIDS and malaria, whereas MDG indicators related to tuberculosis are still below international standards. Therefore, performance was not uniform across programmes. In general, interventions that can be routinely scheduled, such as immunisation, had much higher coverage than those that rely on functional health systems and clinical services proximate to households with 24h availability, such as skilled care at birth. These mixed results highlight that, although MDGs focus on specific diseases and conditions, targets cannot be achieved without strengthening health systems. It is for this reason that the strategic health plan in Ethiopia is focusing on high-impact and cost-effective health interventions and on health systems strengthening.

Poverty, inequality and health: the challenge of the double burden of disease in a non-profit hospital in rural Ethiopia.

This study was aimed at describing disease patterns in a rural zone of Oromiya region, Ethiopia through a retrospective analysis of discharge records for 22,377 inpatients of St. Luke Hospital, Wolisso, Ethiopia in the period 2005-2007. The leading cause of admission was childbirth, followed by injuries, malaria and pneumonia. Injuries were the leading cause of in-hospital deaths, followed by pneumonia, malaria, cardiovascular disease and AIDS. Vulnerable groups (infants, children and women) accounted for 73.3% of admissions. Most of the disease burden resulted from infectious diseases, the occurrence of which could be dramatically reduced by cost-effective preventive and curative interventions. Furthermore, a double burden of disease is already emerging at the early stage of the epidemiological transition, with a mix of persistent, emerging and re-emerging infectious diseases and increasing prevalence of chronic conditions and injuries. This will lead to fundamental changes in the volume and composition of demand for healthcare, with a more complex case mix and more costly service utilization patterns. The challenge is to address the double burden of disease, while focusing on poverty-related conditions and targeting vulnerable groups. Monitoring disease and service utilization patterns through routine hospital information systems can provide sustainable, low-cost support for evidence-based health practice.

Increasing HIV-1 prevalence among pregnant women living in rural areas of the Gulu district (North Uganda).

During the period 1996-99 the prevalence of HIV-1 increased among pregnant women living in the rural areas of Gulu district (North Uganda). This trend could be partly explained by the violent recrudescence of civil strife since 1996 which caused a dramatic reduction in activities of health education and massive population displacement to protected camps. Screening and services for the prevention and control of HIV-1 should be promoted among displaced people. (authors)