Social transmission and the spread of modern contraception in rural Ethiopia

Socio-economic development has proven to be insufficient to explain the time and pace of the human demographic transition. Shifts to low fertility norms have thus been thought to result from social diffusion, yet to date, micro-level studies are limited and are often unable to disentangle the effect of social transmission from that of extrinsic factors. We used data which included the first ever use of modern contraception among a population of over 900 women in four villages in rural Ethiopia, where contraceptive prevalence is still low (<20%). We investigated whether the time of adoption of modern contraception is predicted by (i) the proportion of ever-users/non ever-users within both women and their husbands' friendships networks and (ii) the geographic distance to contraceptive ever-users. Using a model comparison approach, we found that individual socio-demographic characteristics (e.g. parity, education) and a religious norm are the most likely explanatory factors of temporal and spatial patterns of contraceptive uptake, while the role of person-to-person contact through either friendship or spatial networks remains marginal. Our study has broad implications for understanding the processes that initiate transitions to low fertility and the uptake of birth control technologies in the developing world.     

Performance of local light microscopy and the ParaScreen Pan/Pf rapid diagnostic test to detect malaria in health centers in Northwest Ethiopia

Background

Diagnostic tests are recommended for suspected malaria cases before treatment, but comparative performance of microscopy and rapid diagnostic tests (RDTs) at rural health centers has rarely been studied compared to independent expert microscopy.

Methods

Participants (N = 1997) with presumptive malaria were recruited from ten health centers with a range of transmission intensities in Amhara Regional State, Northwest Ethiopia during October to December 2007. Microscopy and ParaScreen Pan/Pf® RDT were done immediately by health center technicians. Blood slides were re-examined later at a central laboratory by independent expert microscopists.

Results

Of 1,997 febrile patients, 475 (23.8%) were positive by expert microscopists, with 57.7% P.falciparum, 24.6% P.vivax and 17.7% mixed infections. Sensitivity of health center microscopists for any malaria species was >90% in five health centers (four of which had the highest prevalence), >70% in nine centers and 44% in one site with lowest prevalence. Specificity for health center microscopy was very good (>95%) in all centers. For ParaScreen RDT, sensitivity was ≥90% in three centers, ≥70% in six and <60% in four centers. Specificity was ≥90% in all centers except one where it was 85%.

Conclusions

Health center microscopists performed well in nine of the ten health centers; while for ParaScreen RDT they performed well in only six centers. Overall the accuracy of local microscopy exceeded that of RDT for all outcomes. This study supports the introduction of RDTs only if accompanied by appropriate training, frequent supervision and quality control at all levels. Deficiencies in RDT use at some health centers must be rectified before universal replacement of good routine microscopy with RDTs. Maintenance and strengthening of good quality microscopy remains a priority at health center level.     

Fertility decline driven by poverty: the case of Addis Ababa, Ethiopia

Demographic transition theory states that fertility declines in response to development, thus wealth and fertility are negatively correlated. Evolutionary theory, however, suggests a positive relationship between wealth and fertility. Fertility transition as a result of industrialization and economic development started in the late 19th and early 20th centuries in Western Europe; and it extended to some of the Asian and Latin American countries later on. However, economic crises since the 1980s have been co-incident with fertility decline in sub-Sahara Africa and other developing countries like Thailand, Nepal and Bangladesh in the last decade of the 20th century. A very low level of fertility is observed in Addis Ababa (TFR=1.9) where contraceptive prevalence rate is modest and recurrent famine as well as drought have been major causes of economic crisis in the country for more than three consecutive decades, which is surprising given the high rural fertility. Detailed socioeconomic and demographic characteristics of 2976 women of reproductive age (i.e. 15-49 years) residing in Addis Ababa were collected during the first quarter of 2003 using an event history calendar and individual women questionnaire. Controlling for the confounding effects of maternal birth cohort, education, marital status and accessible income level, the poor (those who have access to less than a dollar per day or 250 birr a month) were observed to elongate the timing of having first and second births, while relatively better-off women were found to have shorter birth intervals. Results were also the same among the ever-married women only model. More than 50% of women currently in their 20s are also predicted to fail to reproduce as most of the unmarried men and women are 'retreating from marriage' due to economic stress. Qualitative information collected through focus group discussions and in-depth interviews also supports the statistical findings that poverty is at the root of this collapse in fertility. Whilst across countries wealth and fertility have been negatively correlated, this study shows that within one uniform population the relationship is clearly positive.     

Indigenous woody species diversity in Eucalyptus globulus Labill. ssp. globulus plantations in the Ethiopian highlands

The naturally regenerated native woody species diversity was studied ineucalypt plantations at Menagesha, where there was remnant natural forest, and atChancho, where natural forests were absent. A total of 22 and 20 woody speciesbelonging to 18 and 17 families were found, and of these species, treesaccounted for 68 and 55% at Menagesha and Chancho, respectively. About 83% ofthe woody species found in the adjacent natural forest, including importanttimber species were represented in the eucalypt understory at Menagesha.However, the relative abundance of species in eucalypt plantations and theadjacent natural forest varied considerably. Woody species richness andabundance of sample plots at Menagesha were on average 2.4 times and 5.7times higher, respectively, than the sample plots at Chancho. This resultdemonstrates the crucial role of the remnant small patches of natural forest,as a source of diaspores for the restoration of the woody species diversity indegraded areas of the Ethiopian highlands. There was no significant differencein woody species diversity between the eucalypt stand margin and centre. Theunderstory woody species density in eucalypt plantations was up to 8325stems/ha, indicating that the numerous eucalypt stands have a highpotential for restoring the woody species diversity in the Ethiopian highlands.In order to fully re-establish the diverse and economically valuable naturalforest, complementary measures such as enrichment planting of missing primaryforest species may be required.     

Elevational changes in vascular plants richness,diversity, and distribution pattern in Abune Yosef mountain range,Northern Ethiopia

The aim of this research is to investigate the patterns of vascular plant species richness,diversity,and distribution along an elevation gradient in the Abune Yosef mountain range,Ethiopia.Preferential systematic sampling was employed to collect vegetation and environmental data along the elevation gradient.We found that plant species richness declines monotonically from low to high elevations.Specifically,vascular plant species richness and diversity were lower in the Afroalpine grassland(high elevation)than in the Dry evergreen Afromontane forest and Ericaceous forest(low elevations).In contrast,endemic vascular plant richness was significantly higher in the Afroalpine grassland than in the Dry evergreen Afromontane forest and Ericaceous forest.Elevation showed a significant impact on the richness,diversity,and endemism of vascular plants.According to Sorensen's coefficient,the similarity between Dry evergreen Afromontane forest and Ericaceous forest vegetation types is higher(32%)than the similarity between Ericaceous forest and Afroalpine grassland(18%).Only 5%similarity was recorded between the Dry evergreen Afromontane forest and Afroalpine grassland.Growth forms showed different elevationai richness patterns.Trees and liana increased monotonically up to 3300 m.Shrub and herb richness patterns followed a hump-shaped and inverted hump-shaped pattern along the elevation gradient.The elevation patterns of vascular plant species richness,diversity,and growth form in the present study may be attributed to differences in management intensity,spatial heterogeneity,microclimatic variations,and anthropogenic disturbances.     

Crossdating Juniperus procera from North Gondar, Ethiopia

The application of dendrochronology in (sub)tropical regions has been limited by the difficulty in finding trees with distinct annual rings that can be crossdated. Here, we report successful crossdating of Juniperus procera trees from North Gondar, Ethiopia. The trees form annual rings in response to a unimodal rainfall regime. The selection of mesic locations ensured that the trees did not respond to intra-seasonal weather anomalies. Crossdating was achieved by comparison of the wood anatomy directly on the surface of the core samples and purpose-adapted skeleton plotting. Wood-anatomical anomalies, such as false and indistinct rings, were regarded as potentially replicated features and used in crossdating. COFECHA yielded site-specific mean series inter-correlations between 0.52 and 0.59. AMS radiocarbon dating during the bomb era indicated that dating uncertainty is ±1 year.     

Intestinal Parasite Prevalence in an Area of Ethiopia after Implementing the SAFE Strategy,Enhanced Outreach Services,and Health Extension Program

Background

The SAFE strategy aims to reduce transmission of Chlamydia trachomatis through antibiotics, improved hygiene, and sanitation. We integrated assessment of intestinal parasites into large-scale trachoma impact surveys to determine whether documented environmental improvements promoted by a trachoma program had collateral impact on intestinal parasites.

Methodology

We surveyed 99 communities for both trachoma and intestinal parasites (soil-transmitted helminths, Schistosoma mansoni, and intestinal protozoa) in South Gondar, Ethiopia. One child aged 2–15 years per household was randomly selected to provide a stool sample of which about 1 g was fixed in sodium acetate-acetic acid-formalin, concentrated with ether, and examined under a microscope by experienced laboratory technicians.

Principal Findings

A total of 2,338 stool specimens were provided, processed, and linked to survey data from 2,657 randomly selected children (88% response). The zonal-level prevalence of Ascaris lumbricoides, hookworm, and Trichuris trichiura was 9.9% (95% confidence interval (CI) 7.2–12.7%), 9.7% (5.9–13.4%), and 2.6% (1.6–3.7%), respectively. The prevalence of S. mansoni was 2.9% (95% CI 0.2–5.5%) but infection was highly focal (range by community from 0–52.4%). The prevalence of any of these helminth infections was 24.2% (95% CI 17.6–30.9%) compared to 48.5% as found in a previous study in 1995 using the Kato-Katz technique. The pathogenic intestinal protozoa Giardia intestinalis and Entamoeba histolytica/E. dispar were found in 23.0% (95% CI 20.3–25.6%) and 11.1% (95% CI 8.9–13.2%) of the surveyed children, respectively. We found statistically significant increases in household latrine ownership, use of an improved water source, access to water, and face washing behavior over the past 7 years.

Conclusions

Improvements in hygiene and sanitation promoted both by the SAFE strategy for trachoma and health extension program combined with preventive chemotherapy during enhanced outreach services are plausible explanations for the changing patterns of intestinal parasite prevalence. The extent of intestinal protozoa infections suggests poor water quality or unsanitary water collection and storage practices and warrants targeted intervention.     

Attempts to revive Mycobacterium tuberculosis from 300-year-old human mummies

Environmental persistence of Mycobacterium tuberculosis is subject to speculation. However, the reality that infected postmortem tissues can be a danger to pathologists and embalmers has worrisome implications. A few experimental studies have demonstrated the organism's ability to withstand exposure to embalming fluid and formalin. Recently, a failure was reported in an attempt to resuscitate an original isolate of Robert Koch to determine the lifetime of the tubercle bacillus. The present study also considers a historical approach to determine persistence under favorable environmental conditions. It asks whether acid-fast forms observed in tissues of 300-year-old Hungarian mummies can be resuscitated. Finding organisms before the advent of antibiotics and pasteurization may yield valuable genetic information. Using various media modifications, as well as guinea pig inoculation, an attempt was made to culture these tissues for M. tuberculosis. In addition, a resuscitation-promoting factor, known to increase colony counts in high G+C bacteria, was applied to the cultures. Although an occasional PCR-positive sample was detected, no colonies of M. tuberculosis were obtained. Our results may indicate that the life span of the tubercle bacillus is less than a few hundred years, even though in the short run it can survive harsh chemical treatment.     

Adaptive significance of male parental care in a monogamous mammal

Paternal behaviour presumably evolved because male care of young was critical for offspring survival. We report field evidence indicating that paternal behaviour enhances offspring survival in a monogamous mammal, the biparental California mouse, Peromyscus californicus. Male removal resulted in lower offspring survival in father-absent than in father-present families. New males took up residence with widowed females, but usually after females had stopped lactating, suggesting that the importance of the father is not primarily protection against infanticidal intruders but rather direct care of young.     

Are wives and daughters disadvantaged in polygynous households? A case study of the Arsi Oromo of Ethiopia

Whether polygyny is harmful for women and their children is a long-standing question in anthropology. Few studies, however, have explored whether the effect of polygyny varies for women of different wife order, and whether there are different outcomes for their sons and daughters. Because males have higher reproductive variance, especially when they are allowed to take multiple wives, parents may have higher fitness returns from investing in sons over daughters in polygynous households. Moreover, previous studies have found that first wives and their children are advantaged over monogamous and second order wives (who marry into unions later). Here we test the predictions that children of first wives will have an advantage over children to monogamous or second wives, and that sex-biased investment will be strongest among first wives. Using data from the Arsi Oromo of Ethiopia (n ~ 6200 children) we test whether associations with mother's wife order extend beyond childhood into adulthood by examining simultaneously child survival, education and age at marriage. We find that polygynous first wives have no child survival disadvantage, first wives' sons benefit in terms of longer education and daughters have an earlier age at marriage than daughters of monogamous women. Second wives have lower child survival than monogamous women, but surviving children experience advantages in later life outcomes, particularly marriage. These findings challenge the view that polygynous women are always doing the ‘best of a bad job’. Rather, our results suggest that via their surviving sons and daughters there may be long-term benefits for some polygynous women.