John Hunwick

 

Introduction

Adolescent parenthood often places the teen mother and her child at high risk for a variety of negative personal and social outcomes, one of which is an increased risk for abusive parenting (Schellenbach, Whitman and Borkowski, 1992). Adolescent mothers and their children are at a greater risk than children of adult mothers (Bolton, 2000).

Women under 20 years of age are more likely to experience maternal complication than women ages 20 and above (Eure, Lindsay and Graves, 2002; Zabin and Kiragu, 1998). Among 50 developing countries surveyed, an average of 23% of adolescent women, including both married and unmarried women, have given birth or are pregnant. Adolescent childbearing is most common in sub-Saharan Africa, at 25% of women ages 15 to 19. In the Central African Republic, Chad, Guinea, Madagascar, Mali and Niger, over one-third of adolescent women are pregnant or have had a child (Eure, Lindsay and Graves, 2002).

On average, among 16 surveys in Latin America and the Caribbean, 19% of all adolescent women have begun childbearing. The levels are highest in El-Salvador and Nicaragua, at 25%. In nine countries surveyed in Eastern Europe and Central Asia, about 8% of adolescent women are mothers.         

Most adolescents who are married or in a union have begun childbearing. In Latin America and the Caribbean, on average, 80% of married adolescents have begun childbearing, and in sub-Saharan Africa, 73%. Among all developing countries surveyed, South Africa has the lowest proportion of married adolescents who have begun bearing children, at 50%. Elsewhere, the highest level of childbearing among unmarried women ages 15 to 19 is in Nicaragua, at 10%, Nigeria, at 30%, and Ghana at 29% (Eure, Lindsay and Graves, 2002).

Predictors of higher incidence of adolescent childbearing among adolescent mothers have been examined in a variety of studies. Connelly and Strauss (1992) found that the mother’s age when her first child was born was a significant predictor of the occurrence of adolescent mothers. This relationship held even when other variables – such as income, race, education, number of children, and child’s age – were controlled. Bolton (2000) has pointed out that, there are numerous contextual similarities between adolescent parents and adolescent mothers – such as poverty, social isolation, and a poor understanding of child development – which may, collectively, provide the foundations for the development of parenthood.           

Both Belsky (1980, 1993) and Azar (2001) agree that adolescent childbearing is almost always multiply determined, with numerous factors interacting to contribute to the onset of abusive behaviour. Therefore, a risk assessment that measures different areas of risk simultaneously may provide a more comprehensive picture of the characteristics associated with adolescent childbearing among adolescent mothers than do assessments that do not combine multiple components. In the present study four contextual risk factors (social support, maternal psychological adjustment, maternal preparation for parenting and child temperament) were examined in combination as predictors of adolescent childbearing in adolescent mothers.

 

          Psychopathology or personality disturbances in one or both parents has frequently been implicated in the development of adolescent child bearing (Azar, 1991; Wupe, 1987). Most importantly, adolescent parents tend to have more psychological problems than adult mothers (Wurtz-Passino et al, 1993). Therefore, reconceptualizing parental psychological risk for adolescent mothers in terms of psychological adjustment and obtaining a more general assessment of psychological functioning may be more useful than trying to predict behaviour based on the diagnosis of specific clinical disorders.

 

          The importance of social support in the etiology of adolescent childbearing has also been identified (Azar, 2001; Belsky, 1980, 1993; Wolfe, 1985, 1987). Two common correlates of adolescent childbearing that reflect Belsky’s (1980) social support construct are the financial and emotional support available to the family. The socio-economic status (SES) of adolescent mothers and adult mothers frequently differs (Bolton, 2000). Lower SES of adolescent families are more highly represented in poor parenting. This over-representation may be due, in part, to the increased financial stress within families and the decreased availability of family-based financial resources to deal with unexpected expenses related to child care. The emotional support provided by the parents, peers, family, or spouse is also important in distinguishing adolescent mothers and adult mothers (Bolton, 2000; McKenny et al, 1991; Wolfe, 1987). Thus, both SES and emotional support are important aspects of social support reflecting the instrumental and interpersonal components important to a broad-based assessment of this construct.

 

          The third risk construct emphasizes the dysfunctional interaction patterns in adolescent childbearing. That is, a lack of knowledge of child development, unrealistic expectations, and a limited repertoire of skills for interacting with the child are predictive of adolescent child-bearing (Belsky, 1980; Bolton, 2000; de Lissovoy, 1973; McKenny et al, 1991; Schellenbach et al, 1992; Wolfe, 1985). In this way, a mother’s understanding and general expectations about her role as a parent, as well as her beliefs about how she is going to interact with her own child, may be early indicators of insufficient preparation for parenting, thus setting the stage for dysfunctional interaction with their children. This mental preparation for parenting termed cognitive readiness to parent by Borkowski and Colleagues (1992) – was found to be lower for teen than for adult mothers. Therefore, it is important to assess mothers’ preparation for parenting as a reflection of early predispositions towards dysfunctional parenting.

 

          Using the ideas from Wolfe’s (1987) theory, the two components of the psychological predisposition for aggression coping may mediate the relationship between the first four risk factors derived from Bolsky’s (1993) model – that is, social supports, maternal psychological adjustment, child temperament, and preparation for parenting – and the potential for adolescent childbearing. This mediational relationship may provide some understanding of the process through which maternal and early child factors increase the adolescent mother’s susceptibility to childbearing behaviours.

 

          Most research work on adolescent childbearing focused on the nature, causes, and prevalence. It is therefore, not to the knowledge of the researcher that studies linking adolescent childbearing and safe motherhood may have been conducted in Nigeria. It is against this background that this study becomes relevant in filling such missing gaps in our knowledge in the issue of adolescent childbearing and motherhood in Nigeria.    

 

Purpose of this Study

 

          The purpose of this research is to examine the predictive relationships between the contextual risk factors as social supports, maternal psychological adjustment, maternal preparation for parenting and child temperament serve to justify safe motherhood.

 

          In order to achieve the purpose of this research, the following research questions were answered at 0.05 alpha level.

 

1.           To what extent would adolescent childbearing attitudes (as social support, maternal psychological adjustment, maternal preparation for parenting and child temperament) when combined predict safe motherhood among adolescents of reproductive age in Abeokuta Metropolis of Ogun State, Nigeria?         

 

2.           What is the relative contribution of each of the factors to the prediction of safe motherhood among the adolescents?

 

Methodology

 

Research Design

 

          This study focused on adolescent childbearing factors as determinants of safe motherhood among adolescents of reproductive age in Abeokuta Metropolis of Ogun State, Nigeria. A descriptive survey research design was adopted in which questionnaire was employed in collecting data from the respondents on the variables involved in the study.

 

Participants

 

          The target participants for the study is made up all the Pre-degree female students of University of Agriculture, Abeokuta. A total of one thousand and two hundred (1200) female Pre-degree students were randomly drawn from the university Pre-degree female students to take part in the study. The range of participants’ age was between 16 years and 23 years with a mean age of 18.4 years and the standard deviation of 3.67.

 

Instrumentation

 

        Two instruments were used in the study.

 

(i)           Self-reporting Questionnaire on Adolescent Childbearing (SQAC) measures the social supports, maternal psychological adjustment, maternal preparation for parenting and child temperament. It has 25 items rated on a 4 point likert type scale. The respondents are to indicate their degree of agreement with each item by ticking Strongly Agreed (4); Agreed (3); Disagreed (2) and Strongly Disagreed (1). It has 0.64 and 0.69 as the internal consistency and revalidation reliability respectively.

 

(ii)          Motherhood Inventory (MI) measures the characteristics and values attached to the institution of motherhood. It has 20 items response format anchored on Partly True to very Untrue. The test-retest reliability of the inventory was found to be 0.66 and 0.71 respectively.

 

          All the two instruments were author-constructed and were considered valid through the favourable comments of experts in psychometrics on the suitability of the items.

 

Procedure for Data Collection

 

        The participants for the study were administered two questionnaires with the assistance of two research assistants and the University Guidance Counsellor. The collected questionnaires were scored and the data obtained from them were analysed to answer the research questions. On the whole, 1200 copies of the questionnaires were distributed and returned fully filled, giving a return rate of 100%.

 

Data Analysis

 

        The data collected were analysed using multiple regression and chi-square (X2) statistics to establish the relationship between adolescent childbearing and safe motherhood.

 

Results

 

        Results got from the data analysis are presented in Tables 1, 2 and 3.

 

Research Question 1:

 

        To what extent would adolescent childbearing factors when combined predict safe motherhood?

 

Table 1: Regression Analysis on Sample Data using A Combination of Independent Variables to Predict Safe Motherhood.

Multiple R:                 0.351

 

Multiple R-Square:     0.301

 

Standard Error:           3.37

Analysis of Variance

Sources of Variation

Df

SS

MS

F-Ratio

P-Value

Regression

3

5278.832

1759

5.10

<0.05

Residual

1196

517249.688

432.483

Total

1199

522528.512

                                                      

 

          Table 1 shows that the combination of the independent variables (social support, maternal psychological adjustment, maternal preparation for parenting and child temperament) in predicting safe motherhood among the adolescents yielded a coefficient of multiple regression (R) of 0.351, multiple correlation square (R2) of 0.301. The result shows that 30.1% of the variance in the prediction of safe motherhood is accounted for by the independent variables. The table also indicates that, the analysis of variance of the multiple regression data gave an F-ratio of 5.10 significant at 0.05 alpha level.

 

Research Question 2:

 

          What is the relative contribution of each of the factors to the prediction of safe motherhood among the adolescents?        

 

Table 2: Testing the Significance on Relative Contribution to the Prediction of Regression Weight of Independent Variables

S/N

Variables Description

Unstandardized Coefficients

Coefficients

Standardized

t-value

Sig.

B

Std Error

Beta

1

Social support

0.110

0.033

0.205

3.3

<0.05

2

Maternal psychological adjustment

0.124

0.037

0.288

3.3

<0.05

3

Maternal preparation for parenting

2.330

0.469

0.075

4.959

<0.05

4

Child temperament

0.144

0.044

0.022

1.2

NS

5

Constant

35.121

3.915

000

 

 

          Table 2 shows for each independent variable the standardized regression weight (B), the Standard Error Estimate (SEB), the Beta, the T-ratio, and the level at which the T-ratio, and the level at which the T-ratio is significant. As indicated in the table, the T-ratio associated with the four variables (social support, maternal psychological adjustment and maternal preparation for parenting) were significant at 0.05 alpha level. The contribution of child temperament can escalate threat and violence to the prediction of safe motherhood among adolescents of reproductive age. The degree of contribution of each of the variables in order of merit are: maternal preparation for parenting (B=2.330; t=4.959; p<0.05); social supports (B = 0.110; t = 3.3; P<0.05); maternal psychological adjustment (B = 0.124; t = 3.3; p<0.05); and child temperament (B = 0.144; t = 1.2; p>0.05).

 

Table 3: X2 Summary on Adolescent Childbearing Factors and Safe Motherhood. 

 

 

Variable Description

X2 Cal

Df

X2 tab

Sig (2 tailed)

1

Social support

16.986

3

7.81

0.001

2

Maternal psychological adjustment

29.762

3

7.01

0.000

3

Maternal preparation for parenting

33.956

3

7.81

0.000

4

Child temperament

5.969

3

7.81

0.113

* Significant at 0.05 alpha level

 

          The result on table 3 shows that each of the independent variables made significant contribution to the prediction on safe motherhood at 0.05 alpha level. This implies that there is a strong relationship between those factors and safe motherhood. The contributions of each of the variables shows that maternal preparation for parenting (X2 = 33. 956) has the most potent variable followed by maternal psychological adjustment, (X2 = 29.762); social supports (X2 = 16.986); and child temperament (X2 = 5.969) in that order.   

 

Discussion of Findings

 

        The major goal of this study was to find out the influence of adolescent childbearing factors as determinants of safe motherhood.

 

          It is on the above premise that the findings of the present investigation is reported. The result on Table 1 showed that adolescent childbearing factors either collectively or relatively predict safe motherhood. The joint combination of the four variables when taken together and regressed against safe motherhood account for 30.1% of the variance (R-square = 0.201). This is statistically significant as corroborated by the analysis of variance result of 5.10. This result agree with the findings reported by Bolton (2000); Eure, Lindsay and Graves (2002); Belsky (1980, 1993) and Azar (2001). This agreement was also supported by Wolfe (1987) and Belksky (1980).

 

          Maternal preparation for parenting was shown to significantly relate to safe motherhood. This result agrees with Borkowski and colleagues (1992). The result obtained in the study also showed that social support was a significant contributor to the prediction of safe motherhood. This finding supports the report of Bolton (2000); Azar (2001); Belsky (1980, 1993) and Wolfe (1985, 1987). Maternal psychological adjustment was considered significant in this study. This finding supports the work of Wolfe (1987) and Belsky (1980). Child temperament was not found to significantly predict safe motherhood. This result was however at variance from the work of Belsky (1980 and Wolfe (1987).

 

Conclusion and Recommendations

 

        Adolescent childbearing in any society of the world has been viewed as a social and health problem that requires urgent attention of well-meaning citizens. It is on this premise that the following recommendations are provided:

 

(i)           The government of Nigeria should as a matter of urgency adopt a National Adolescent Reproductive Health Policy.                   

 

(ii)          Youth centres be opened to provide information on family planning, reproductive and sexual health, and STIs and their treatment.

 

References

 

Azar, S.T. (1991). Models of child abuse: A metatheoretical analysis. Criminal Justice and Behaviour, 18, 30-46.

 

Azar, S.T. (2001). Child abuse and unrealistic expectations: Further validation of the parent opinion questionnaire. Journal of Consulting and Clinical Psychology, 54, 867-868.  

 

Belsky, J. (1980). Child maltreatment: An ecological approach. American Psychology, 35, 320-335.

 

Belsky, J. (1993). Etiology of child maltreatment: A developmental ecological analysis. Psychological Bulletin, 114, 413-434.

 

Bolton, F.G. (2000). “Normal” violence in the adult child relationship: A diathesis-stress approach to child maltreatment within the family. Family Abuse and Its Consequences (pp. 61-75). London: England Sage Publications.

 

Connelly, C.O. and Strauss, M.A. (1992). Mother’s age and risk for physical abuse. Child Abuse and Neglect, 16, 709-718.    

 

de Lissovey, V. (1973). Child care by adolescent parents. Children Today, 2, 22-25.       

 

Eure, C.N., Lindsay, M.K. and Graves, W.L. (2002). Risk of adverse pregnancy outcomes in young adolescent in an inner city hospital. American Journal of Obstetrics and Gynecology 186(5): 918-920.

 

McKenny, P.C., Kotch, J.B. and Broune, D.H. (1991). Correlates of dysfunctional parenting attitudes among low income adolescent mothers. Journal of Adolescent Research, 6, 212-234.

 

Schellenbach, C.J., Whitman, T.L. and Borkowski, J.G. (1992). Towards an integrative model of adolescent parenting. Human Development, 35, 81-99.

 

Wolfe, D.A. (1985). Child-abuse parents: An empirical review and analysis. Psychological Review, 97, 463-482.

 

Wolfe, D.A. (1987). Child abuse: Implication for child development and psychopathology (Vol. 10). Newbury Park, C.A.: Sage Publication. 

 

 

OLADEJI DAVID

 

Authors:Bhurgri Ghulam Rasool,Momina Taki Muhammad,Shamim-Ur-Rehman,ShahMurad,RajKumar Chohan,DahriGhulam Mustafa, Shaikh zulfikar,

INTRODUCTION:

TUBERCULOSIS:

Tuberculosis, one of the oldest diseases known to affect human, is caused by bacteria belonging to mycobacterium tuberculosis complex. The disease usually affects the lungs, although in up to one third of cases other organs are involved. If properly treated, tuberculosis caused by drug susceptible strains is curable in virtually all cases. If untreated, the disease may be fatal within 5 years in more than half of cases. Transmission usually takes place through airborne spread of droplet nuclei produced by patients with infectious pulmonary tuberculosis (Mario C Raviglione, Richard JO Brein, 2003).

Tuberculosis is a disease of great antiquity. Today, tuberculosis gas become the most important communicable disease in the world, with over 8 millions cases of pulmonary tuberculosis occurring each year 95% which are in developing countries (A Gordon Leitch, 2000).

Tuberculosis is chronic granulomatous disease of human and other mammals caused by a group of closely related obligate pathogens, the mycobacterium tuberculosis complex, and comprising M. tuberculosis. The human tubercle bacillus - M. bovis - the bovine tubercle bacillus, -agricanum - a heterogeneous type found principally in effuational Africa with properties intermediate between the former two species and M-microti-a rare cause of disease involves and other small mammals but attenuated for humans. (PDO D awis et al, 2003).

Annual risk of infection

Areas

Current

Level

Annual decline

Trend (%)

Health resource

Availability

Industrialized

0.04-0.1

>10

Excellent

Middle income Latin America

West Asia

0.5-1.5

5-10

Good

Middle income East and South

Eest Asia

1.0-2.5

<5

Good

Sub-Saharan Africa

Indian Subcontinent

1.0-2.5

0-3

Poor

                                                                                                                                (A Gordon Leitch, 2000)

In 1994 World Health Organization (WHO) declared that tuberculosis (TB) constituted a global emergency. It developed a five point strategy known as direct observe treatment strategy (DOTS) in order to combat the increasing incidence of the disease. The main aim was to detect 70% of smear positive tuberculosis (TB) cases and to treat85% of smear positive new cases successfully. This strategy has improved worldwide cure rates. Tuberculosis is an increasingly important cause of morbidity and mortality in refugees and displaced populations, particularly during the post acute phase of complex emergencies (Alison H Rodger et al., 2002).

EPIDEMIOLOGY:

In Pakistan, only limited data is available, however, the prevalence of tuberculosis is estimated to be as high as 250,000 cases annually. According to official estimates, the rate of open bacillary cases among adult population (15 years and above), was 17% and among children 5 to 9 years of age, 13% were infected with tuberculosis. It is thought to be the fourth major cause of all deaths in Pakistan (Shamim A Qazi et al., 1998).

PATHOLOGY OF TUBERCULOSIS:

CASE WITH INFECTOUS TUBERCULOSIS

Cough and generate droplet nuclei which are ingaled by a contact

Primary

Onset of CMI response

Bacillimia                                                   Apical Implant

Sterilization of the primary complex

Immunosuppressive event

Multiple of tubercle bacilli

Restoration of CMI

Caseation of necrosis

        Infectous tuberculosis

Figure: Schematic representation of the basic events in the pathogenesis of tuberculosis.

CMI: Cell mediated immune.

(VB Balasurbramanian et al., 1994).

DRUG TREATMENT OF TUBERCULOSIS

Tuberculosis is among the top ten cause of global mortality and affects low icome countries in particular. The treatment of smear positive tuberculosis using World Health Organizzation (WHO) directly  observed treatment, short course, Direct observe treatment strategy (DOTS) has far highest impact while BC immunization recuces childhood tuberculosis mortality (Martien W Borgdorff et al.m 2002).

Drugs used in the treatment of tuberculosis can be divided into two major categories. First line after combined the greatest level of efficacy with unacceptable degree of toxicity. These include isoniazid, rifampin, ethambutol, streptomycin and pyrazinamide. Excellent results for patients with non drug resistant tuberculosis can be treated with 6 month course of treatment, for the first 2 months, isoniazid, rifampin and pyrazinamide are given, followed by isoniazid and rifampin for remaining 4 months (William A Petri Jr, 2001).

RIFAMPIN

Rifampin is a semisynthetic broad spectrum bactericidal antibiotic derived from streptomyces mediaterani.The introduction of this antibiotic that permitted the development of the first effective short course of 9 month chemotherapy for tuberculosis.

It is an addition of antituberculosis activity, it has wide range of activity against other bacteria including staphylococcus, Streptococcus, Clostridium, Coliforms, Pseudomonas, Proteus,Shigella and Legionella. Rifampin is almost completely absorbed from gastrointestinal tract after an oral dose. When it is taken is an empty stomach the plasma levels of 6-7 ug/ml are reached at 3 hours and its half-life of about 5 hours (A Gordon Leitch, 2000).

Adverse effects:

Rifampin dependent antibodies are considered responsible for most of immunological side effects in which hepatotoxicity, thrombocytopenia and allergic reactions are important (Mehta YS et al., 1996). Rifampin causes anorexia, nausea, vomiting, diarrhea, fever, dizziness, bone pain, shortness of breath, urine and saliva are colored orange red (Cheema MA, 2000).

ISONIAZID

Since its  introduction in 1952 isoniazid has been widely recognized as a safe and effective chemotherapeutic agent against tuberculosis. Numerous studies of isoniazid in combination with other tuberculous drugs have repeatedly demonstrated its therapeutic efficacy (Richard et al.,1972).

Isoniazid is the most widely used antituberculosis agent. It is an ideal in many aspects, being bactericidal, relatively non-toxic easily administered and inexpensive. It is readily absorbed from the gastrointestinal tract, with peak concentration of approximately 5ug/ml occurring about 2 hour after administration. It penetrates to all tissues including cerebrospinal fluids (C.S.F.) some part of drug excreted in urine in unchanged form but proportion is acetylated by hepatic acetyl transferase to an inactive form. Drug is usually given orally with combination of rifampin and pyrazinamide are available (A Gordon Leitch, 2000). Isoniazid is still most important drug world wide for the treatment of all types of tuberculosis. The commonly usual dose is 10-50 mg/kg/day with maximum of 300 mg (William A Petri Jr, 2001).

The incidence of adverse effects of isoniazid are skin rash, fever , jaundice hypersensitivity to isoniazid may result in fever, various skin eruption occurs (William A Petri Jr, 2001).

Isoniazid preventive therapy is contraindicated in persons with chronic active hepatitis should be given caution to person who consumes alcohol daily (M Suess, 1994).

ETHAMBUTOL

Ethambutol is a synthetic, water soluble, heat stable compound. Susceptible strains of Mycobacterium tuberculosis and other mycobacteria are inhibited in vitro by ethambutol. Ethambutol is an ingibitor of mycobacterial arabinosyl transferases, which are encoded by the embCAB operon. Arabinosy1 transferases are involved in the polymerization reaction of arbinoglycan, an essential component of the mycobacterial cell wall (Henry FC, 2001). It is rapidly absorbed from intestine. It is excreted in urine. It should not be given in renal disease (MA Cheema, 2000). The most important side effect is optic neuritis, resulting decrease of visual acuity and loss of ability to differentiate red from green (William A Petri Jr, 2001).

Hypersensitivity to ethambutol is rare. The most common serious adverse event is retrobulbar neuritis causing loss of visual acuity and red green color blindness. The dose related side effect is more likely to occur at a dosage of 25 mg/kg/day continued for several months. The peripheral neuropathy owing to demyelinization. Other less common adverse effects include gastrointestinal intolerance, hyperurecemia, and hypersensitivity reactions including rash, and rarely thrombocytopenia. It is safe during pregnancy with no known teratological effects (Edwards D,Chan,2003).

PYRAZINAMIDE

Pyrazinamide is bactericidal in an acid environment and as sterilizing effect on intracellular mycobacteria. It is well absorbed from gastrointestinal tract, with peak concentration of about 50ug/mloccurring 1.5-2 gour after ingestion. It penetrates well into tissues including cerebrospinal fluid (A Gordon Leitch, 2000).

Pyrazinamide is synthetic orally effective bactericidal ant tubercular agent used along with isoniazid and rifampin (William A Petri Jr, 2001).

The reasons for this increased incidence of hepatotoxicity reactions in developing countries are unclear, Perhaps poor nutrition, increased age, wide spread parasitism, chronic infections, indiscriminate use of various drugs without prescription may play a role individually or collectively (H Turktas et al.,1994).

Gastrointestinal reactions, cutaneous reactions, sidiroblastic anemia (A Harries, 2003). Moreover pyrazinamide is considered to be significantly less hepatotoxic than isoniazid and rifampin. Less common adverse reactions to pyrazinamide include rhabdomyolysis with myoglobinuric renal failure, gouty arthritis, photosensitivity, maculopapular raxh, thrombocytopenia, increased serum iron, urticaria, and other hypersinsitivity reactions (Edward DE Ehan et al., 2004).

STREPTOMYCIN

Streptomycin is tuberculocidal, but less effective than isoniazid or rifampin, acts only on extracellular bacilli (because of poor penetration into cells). Thus, host defense mechanisms are needed to eradicate the disease. It penetrates tubercular cavities, but does not cross to the cerebrospinal fluid (CSF), and has poor action in acidic medium. Resistance developed rapidly when streptomycin was used alone in tuberculosis most patients had a relapse (Tripathi, 2003). Streptomycin is bactericidal for tubercle bacillus in vitro. Concentration as low as 0.4 mg/ml may inhibit the growth. Vast majority of strains of mycobacterium tuberculosis are sensitive to 10mg/ml (William A Petri Jr, 2001)

Untoward effects include rash and fever, auditory and vestibular function of eighth cranial nerve is affected (William A Petri Jr, 2001).

BCG

Unfortunately, the protective efficacy of BCG, the most widely used vaccine against pulmonary tuberculosis varies from 0% to 80%. BCG gives good protection (75-80%) against disseminated tuberculosis includes tuberculous meningitis, in childhood, BCG is given at birth or as soon as possible, therefore after and although the duration of protection is uncertain, it may not be longer than 15 years, this limiting protection against infectious pulmonary tuberculosis, which may occur mainly in adults (Martein W Borgdorff et al., 2002).

Today over, 70 years of BCG development, it is still the only tuberculosis vaccine availed, and the achievements of tuberculosis vaccine research have been largely operational, such as expanding delivery of BCG through the expanded programe on immunization and holding field trials in different geographical locations (Ann M Ginberg,2002).

MATERIAL AND METHODS

This study was carried out in the department of Pharmacology and Therapeutics, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre, Karachi, from January 2005 to June 2005.

The 100 newly diagnosed patients of pulmonary tuberculosis, enrolled is this study after taking informed and written consent.

The patients were selected as diagnosed cases of pulmonary tuberculosis from medical chest OPD and chest ward of Jinnah Postgraduate Medical Center, Karachi. Out of these 97 patients were associated through out the study period. Out of remaining three have not come for follow up.

                                     

All patients, in this study, were selected according to following criteria:

INCLUSION CRITERIA:

• Diagnosed cases of pulmonary tuberculosis.
• Age between 2o to 70 years.
• Sex either male or female.

EXCLUSION CRITERIA:

• Patients suffering from liver disease.
• Patients suffering from cardiac disease.
• Patients suffering from renal disease.
• Patients suffering from diabetes mellitus.
• Patients suffering from other respiratory disease.
• Patients suffering from HIV infections.
• Pregnant or nursing women.
• Patients with previous multiple drug resistance.

The study period extended up to 24 weeks and 12 follow up visits of patients were taken. The required information such as name, age, sex, occupation, address, details of follow up visits and laboratory investigations etc, of each patients were recorded on proforma especially designed for this study.

The selected patients were divided according to untoward effects of drugs during study period.

Group1:                 In this group those patients were included who manifested the hepatitis in different age groups

Group2:                 In this group those patients were included who manifested the peripheral neuropathy inh defferent age groups

Group3:                 In this group those patients were included who manifested the skin rashes in different age groups

Group4:                 In this group those patients were included who manifested the joint pain in different age group

Group5:                 In this group those patients were included who manifested the optic neuritis in different age group

Group6:                 In this group those patients were included who manifested the thrombocytopenia in different age group

Group7:                 In this group those patients were included who manifested the nephrotoxicity in different age group

Group 8:                In this group those patients were included who manifested the ototoxicity in different age group

MATERIALS

• Isoniazid—adult 5 mg/kg -maximum 300 mg
• Rifampin—-adult 10 mg/kg -maximum 450 mg
• pyrazinamide 15-30 mg/kg
• Ethambutol 15-25 mg/kg-maximum 300 mg
• Streptomycin — 15 mg/kg - maximum 1 gm
• Disposable syringes.
• C.P. bottles.
• Kits for the liver function test, measurement of urea, creatinine

Ninety seven patients were studied after medications with anti tuberculosis therapy and divided in eight groups after the manifestation of untoward effects of therapy.

The observations of all the treatment groups were recorded on day 0, day 30 and day 80.

Table 1 and figure 1 show hepatitis after taking the anti tuberculosis drugs. The hepatitis was manifested more in combined therapy during medication of pulmonary tuberculosis. The hepatitis found significant different with p < 0.01 among anti tuberculosis therapy. Out of 97 patients, there were 15 patients were affected by this untoward effect. The highest proportion of hepatitis in isoniazid (10.3%) followed by pyrazinamide (3.1%) and rifampin (2.1%

 The hepatitis in different age groups. The decade between 20-29 of age has shown maximum number of hepatitis (5.1 & followed by the extreme age 60-69 years (P<0.05), keeping the high proportion of isoniazid as compared to pyrazinamice (1.03%) and rifampin (2.06%) in different age groups. Isoniazid manifested 4 cases of hepatitis in age group 20-29 years, pyrazinamide 1 respectively. Four patients produced hepatitis in age between 60 to 69. Pyrazinamide produced hepatitis in age between 60 to 69. Pyrazinamide produced hepatitis (2.66%). INH and rifampin affected with equal percentage (1.03%). Two patients were produced hepatitis in age between 30-39 years. The INH and rifampin affected with equal (1.03%) in this age group respectively. It was non significant statistically. One patient was affected by isoniazid in the age group of 50-59 years. It was non significant statistically

 The peripheral neuropathy in 25 patients out of 97 patients. The isoniazid produced more peripheral neuropathy than other causative drugs. The isoniazid affected 11.3% patients. The pyrazinamide and ethambutol produced the peripheral neuropathy in same percentage (7.2%). It was non significant statistically.

The peripheral neuropathy in different age groups. The age between 60 and above was more affected than other age groups. Isoniazid produced 602% peripheral neuropathy in this age group. Ethambutol produced 1.03% peripheral neuropathy. The age group between 20-29 developed peripheral neuropathy by isoniazid 301%, pyrazinamide 2.01% and ethambutol 1.03% respectively. The total patients were 6 with this age group. The age between 30-39 manifested peripheral neuropathy by isoniazid 1.03% and ethambutol 1.03% respectively. The age between 40-49 was affected by peripheral neuropathy by pyrazinamide 3.1% and ethambutol 3.1%                                                                                                  

Therapy produced, 3 patients, thrombocytopenia. The rifampin produced thrombocytopenia in 3.1% males.

 Thrombocytopenia according to age groups. The combined therapy affected in age between 40-49, 1.03%, 50-59, 1.03% and 60 and above 1.03% respectively. The rifampin produced this side effects with same percentages i.e. 1.03% in age groups 40-49, 50-59 and above.

            Table 10 and figure 10 show the joint pain as an adverse effect of anti tuberculosis drugs. The combined therapy affected 8 patients out of 97. pyrazinamide produced joint pain in 8.24% patients.

Table 12 and figure 12 show the joint pain according to age groups. The pyrazinamide affected 3.09% in age between 60 and above, 2.06% in age between 20-29 and 1.03% in further age groups respectively.

 The optic neuritis. The combined therapy produced optic neuritis in 7 patients out of 97. ethambutol produced 7.2% optic neuritis

 The optic neuritis according to age groups. The combined therapy produced the optic neuritis in 3 in 6o to69, 2 in 50-59 and one in 30-39 and 40-49 years respectively. The ethambutol produced the optic neuritis in 3.09 in age between 60-69, 2.06% in 50-59 and 1.03% in 40-49 and 30-39 tears.

 Skin rashes as an adverse effect of anti tuberculosis drugs. The skin rashes found significant (P<0.01) by combined therapy. The combined therapy produced skin rashes in 6 patients out of 91 patients. The pyrazinamide produced skin rashes (4.12%) and rifampin produced 2.1% respectively.

Skin rashes in age groups. The combined therapy produced skin rashes in 2 from 20-29 years age group, 1 from 40-49 years, 1 from 60-69 respectively. The pyrazinamide produced skin rashes 2.06% in age between 20-29 years, 1.03% in 50-59 years, 1.03% in 60-69 years age group, 1.03% in 50-59 years respective

 Nephrotoicity as an adverse effect. Streptocomycin was main drug to manifest the nephrotoxicity in combined therapy during treatment of pulmonary tuberculosis in combined therapy during treatment of pulmonary tuberculosis patients. Out 97 patients, there were 3 reactions documented in this study.   Nephrotoxicity in gender after taking the anti tuberculosis drugs. Two males and one female was affected during the study

The nephrotoxicity in different age group. In the age group 30-39 1, 40-49 1, and 50-59 1 reaction was documented in this study.

 The ototoxicity after taking anti tuberculosis drugs. There were 2 reactions recorded in this study.

Adverse effect

Pyrazinamide

Isoniazid

Ethambutol

Rifampin

Streptomycin

Total

%

95% CI

Peripheral neuropathy

7 (7.2%)

11 (11.3%)

7 (7.2%)

-

-

25

25.8

17.80-35.1

Hepatitis

3 (3.1%)

10 (10.3%)

-

2 (2.1%)

-

15

15.5

9.2-23.7

Joint pain

8 (8.2%)

-

-

-

-

8

8.20

3.9-15.0

Optic neuritis

-

-

7 (7.2%)

-

-

7

7.20

3.2-13.7

Skin rashes

4 (4.2%)

-

-

2 (2.1%)

-

6

6.20

2.5-12.4

Table show overall side effects of ATT in this study.

FIGURES:

Overall Frequency of Adverse Effect

(n=69)

DISCUSSION:

This study observed the untoward the untoward effects of antituberculous drugs in pulmonary tuberculosis patients. The selected patients were divided into two groups according to the age and sex. In this study the following reaction i.e., hepatitis, peripheral neuropathy, thrombocytopenia, joint pain, optic neuritis, ototoxicity and nephrotoxicity were recorded in the first line antituberculous drugs used in pulmonary tuberculosis patients.

The adverse effects of antituberculous drugs i.e., isoniazid (INH), pyrazinamide, rifampin, ethambutol and streptomycin were observed during this study, discussed here.

Isoniazid (INH) 300 mg per day was started in selected 97 tuberculosis patients. The major side effects were recorded after two weeks of medication, which included hepatitis and peripheral neuropathy.

Hepatitis – there were 10 reactions of hepatitis were documented in this study. In a group of gender, there were 7 reactions in male and 3 reactions in female. According to age group between 20-29, the isoniazid produced 4 reactions, 3 reactions in 40-49, 1 reaction in other age groups. Isoniazid was stopped but remaining other drugs rifampin, pyrazinamide, ethambutol and streptomycin were continued in these patients.

After the stoppage of isoniazid, the liver function test was normal in 6 cases, isoniazid was reintroduced after 2-3 weeks with dose of 50 mg per day and was increased subsequently to 300 mg per day. There were 4 cases referred to the Medical Outpatient Department (OPD) for management of liver disease.

Peripheral neuropathy – isoniazid produced 11 reactions of  peripheral neuropathy out of 25 reactions in this study. According to gender, 4 reactions were produced in male and 7 reactions in female. According to age group the peripheral neuropathy produced in age group 30-39 and 40-49 respectively. This showed the higher side effect of isoniazid in older age group.

Pyrazinamide (1-2 g/day) – the major side effect of this drug were produced after 3-4 weeks of medication. The hepatitis 3, peripheral neuropathy 7, joint pain 8, and skin rashes were documented in this study.

Hepatitis – the pyrazinamide produced 3 reactions of hepatitis in this study. According to gender, 1 male and 2 female reactions were recorded in this study. According to age, pyrazinamide produced 2 reactions in age group of 60-69 and 1 reaction 20-29 of age group. The 1 reaction of pyrazinamide was subsided when drug was stopped. But 2 reactions in older age group, the liver function test did improved and they were referred to the Medical Outpatient Department (OPD) for the management of liver disease.

Peripheral neuropathy – there were 7 reactions caused by pyrazinamide were documented in this study, according to gender, 2 reactions in male and 5 reactions in female according to age group, age between 50-59 3 reactions and 1 reaction in age group 20-29 and 40-49 respectively. These reactions were reversible after decreasing dose of pyrazinamide.

Skin rashes – the pyrazinamide produced 4 reactions out of 6 reactions of antituberculous drugs in this study. According to gender, in female 3 reactions and 1 reaction in male were recorded in this study. According to age group, 2 reactions were recorded in age group of 20-29 and 1 reaction in 50-59, 60-69 respectively. Skin rashes were subsided after stoppage of pyrazinamide for 3 weeks.

Joint Pain – there were 8 reactions of joint pain documented in this study. This study showed that pyrazinamide was only causative drug for joint involvement, the uric acid level was done before and after the start of drug. A remarkable increase level of uric acid was noted after the pyrazinamide treatment. Thus the drug was stopped in these 8 patients and later the level of uric acid significantly decreased and joint involvement clinically improve.

                Ethambutol was administered at dose of 15-30 mg/Kg/Day. The side effects of this drug were manifested after 2-3 weeks of treatment. The peripheral neuropathy and optic neuritis were recorded as main side effects.

Peripheral neuropathy – there were 7 reactions of peripheral neuropathy recorded in this study. The ethambutol produced these reactions in 2-4 weeks after starting of treatment. According to gender, 5 in female and 2 reactions in male, were observed in this study. According to age group, 3 reactions in 50-59 and 1 reaction in each age group respectively. These reactions were reversible after stoppage of the drug.

Optic neuritis – the ethambutol produced the 7 side effects of optic neuritis in this study. According to gender, male manifested 4 and female 3 reactions of optic neuritis in this study. According to age group 3 reactions in 60-69 age group and 2 in 50-59 group and 1 reaction in 50-59, 30-39 age group respectively in this study. Drug was discontinued in these 7 cases of optic neuritis but the remaining four other drugs were continued. They were referred to Eye Outpatient Department for the management of optic neuritis. Only in two patients drug was reintroduced with low dose 15-20 mg/Kg/Day.

Rifampin (450 mg/day) – after 2-3 weeks of starting with combined therapy, the major side effects were manifested. When this drug was hold, the hepatitis 2 and skin rashes 3 were improved and reactions of thrombocytopenia were documented in this study.

Hepatitis – according to gender, 1 reaction of hepatitis in male and 1 in female produced by rifampin. According to age group, 1 reaction in 30-39 and 60-69 were produced by rifampin. One side effect of hepatitis was improved when drug was stopped after one week and other patient was referred to Medical out patient department for further management.

                Skin Rashes – the rifampin developed the skin rashes in two patients; one in male and one in female in this study. According to age group, 1 adverse effect in 40-49 and 50-59 were observed respectively. These skin rashes were reversible after stoppage of drug.

Thrombocytopenia – after 5-11 weeks of treatment of tuberculosis patients, the level of platelets were decreased and clinically the patients were complaint epistaxis, bruises, and petechial rashes. Rifampin was stopped in 3 patients but the remaining other four drugs were continued.

Streptomycin (1 g per day) – it was started with other drugs. After 3-7 weeks of medication, 3 patients complaint of oliguria and 2 patients presented during follow up with hearing deficit. These reactions proved clinically and laboratory investigations.

Nephrotoxicity was recorded in these patients two in male and 1 in female. According to age group 1 in 30-39, 2 40-49 and 1 50-59 side effects were documented in this study. Drug was stopped for 3 weeks and found that blood urea nitrogen and creatinine levels were decreased, therefore this drug was permanently stopped and the remaining four drugs were continued.

The proximal renal tubule cells may accumulate aminoglycoside, accounting for nephrotoxicity associated with aminoglycosides. The mechanism of renal toxicity is hypothesized to by the inhibition of intracellular phospholipase in the proximal tubule. The renal insufficiency is typically characterized by the nonoligouric decrease in glomerular filtrate rate occurring after at least taking a week therapy. Baseline and periodic surveillance of analysis blood urea nitrogen levels, creatinine values is indicated (Edward et al., 2004).

Streptomycin is nephrotoxic and should used with caution in patients with renal impairment. If reaction is trouble some which is an infrequent occurrence, the dose may be reduced (NCG,2002).

Ototoxicity – there were 2 reactions recorded in this study. According to gender, 1reaction was in male and 1 in female was documented in this study. Side effects of streptomycin were recorded. One in age group 20-29 and one in 40-49. The drug was a stopped and patients were advised to consult in Ear Nose and Throat OPD. Remaining other drugs were continued.

Interestingly, the damage may be fairly isolated to either the choclear or vestibular component, or rarely both. The mechanism for the cochlear toxicity is unclear, although the target site is considered to the outer hair cells of the organ of corti.

Aminoglycoside induced cochlear dysfunction is generally considered to be irreversible. Injury to the hair cells of the ampullar cristae by aminoglycosides is the mechanism of the vestibular toxicity. Sign and symptoms of vestibular toxicity include nausea, vomiting, vertigo and nystagmus (Edward et al., 2004).

Our study matches with study of Menzies et al (2005), who observed the side effects of antituberculous therapy. They reported that at least monthly a nurse, a case manager, a treating physician saw the 430 test patients who had active tuberculosis therapy . At the time of their visit patients were questioned specifically about the occurrence of common side effects of their tuberculosis drugs. Liver enzyme levels were checked routinely in all patients after one month of treatment. Patients were encouraged to return at any time if symptoms or problems arose during therapy.

The striking observation is that pyrazinamide was association with rate of toxicity that was threefold higher than isoniazid and rifampin and 20-fold higher than ethambutol. The rate of toxicity with pyrazinamide was 1.5 per 100 person – months compared with 0.5 per 100 person – months for isoniazid. Pyrazinamide rashes attributed to pyrazinamide may have led to in appropriate drug discontinuation. It seems that pyrazinamide-related rashes usually resolve spontaneously and not considered a reason to stop therapy. While in this study the rate of toxicity of pyrazinamide was higher than isoniazid and rifampin. Therefore, causative drugs like pyrazinamide, isoniazid and rifampin was stopped, because they induced hepatitis, which increase risk of liver damage. However, ethambutol and streptomycin were continued in this study.

In case of skin rashes, pyrazinamide was responsible drug but it was discontinued from therapy, skin rashes were improved after three weeks.

                There was a difference between this study and Menzies study may be due to short duration of study period, difference in number of patients studied. Moreover, his study conducted in United States of America. In this study there was a short duration of study and small selected number of patient and many environmental factors were involved. The patients selected in this study belong to poor socioeconomic class and they could not repeatedly visit Doctors for their checkup the occurrence of side effects of antituberculous drugs.

The British Thoracic Society (1998) guides that if the aspartate aminotransferase and alanine transferase are two or more times normal, liver function should be monitored for two weeds, then two weekly until normal. If the aspartate aminotransferase and alanine transferase under two times normal, liver function should be repeated at two weeks. If the aspartate aminotransferase and alanine transferase level rises to five times normal or bilirubin level rises, rifampin, isoniazid and pyrazinamide should be stopped. Alternative treatment will need to be considered if the patient is unwell or is smear positive and within two weeks of starting treatment.

Reactions most frequently observed with intermittent regimens of rifampin are cutaneous syndrome consisting of flushing and/or pruritus, with or without rash, involving particular face, and scalp, often with redness and watering of eye (Fried et al., 2004). Pyrazinamide produce GIT reactions, cutaneous reactions and sidero blastic anaema (Harries, 2004).

The results of this study matches with the study of Pelletier et al (2003), who observed the side effect of antituberculous drugs in 4.30 patients between 1990-99. They stated that the major adverse reaction of first line antituberculous drug, which results in discontinuation of that drug, has severely implication. They may be considerable morbidity even mortality particular may drug-induced hepatitis. Alternative agents may gave greater problems with toxicity and often less effective so that treatment must be prolonged, with attendant challenged to ensure complains as a risk of treatment failure and relapse are higher. In their results, only 37 patients had major side effects on six occasions. Severe hepatitis resulted in discontinuation of the isoniazid and pyrazinamide and neither were restarted. In three instances (two of rash and one of the severe gastrointestinal intolerance). Rifampin and pyrazinamide were stopped not rechallenged. They observed the rifampin did not commonly cause the drug-induced hepatitis. The drug mostly responsible for occurrence of hepatitis or rash during therapy of antituberculosis in tuberculosis hepatitis or rash during therapy of antituberculosis in tuberculosis patients was pyrazinamide.

                In this study, pyrazinamide manifested more side effects than other antituberculous drugs were documented according to age and gender. But incidence of drug-induced hepatitis was observed more in isoniazid than other antituberculous drugs. The rifampin had shown less side effects than other antituberculous drugs.

                The occurrence of side effects in the present study was noted to be much higher than the study done by Pelletier and colleagues. In this study there is a short duration of study and small selected number of patient and many environmental factors were involved. The patients selected in this study belong to poor socio-economical class and they could not repeatedly visit Doctors for their checkup the occurrence of side effects of antituberculous drugs.

Hepatotoxicity is one of the most serious adverse effects of anti tuberculosis drugs (ATD). Although many risk factors gave been associated with antituberculosis drugs induced hepatotoxicity, their influence on hepatitis severity has not been studied systematically. This study evaluated whether the presence of hepatotoxicity risk factors (advanced age, chronic liver diseases, abuse of alcohol or other drugs or malnutrition) influences the severity of ATD induced hepatotoxicity (Villar et al., 2004).

The results of present study match with the study of Fernanoted it al (2004). Their prospective cohort study of 471 active tuberculosis diseased patients treated with isoniazid, rifampicin and pyrazinamide were followed in tuberculosis clinic between January 1998 and July 2002. The incidence of antituberculous drug induced hepatitis was 18.2% patients in a risk group and 5.8% patients in non-risk group. Antituberculous drug-induced hepatitis is a significant and more severe in patients with risk factors. Our study correlates with this study because our big part of population live in a risk factor i.e., poverty, malnutrition, lack of clean water, combine family structure, high prevalence of viral hepatitis. So in our study there were more cases of hepatitis due to pyrazinamide, isonaizid and rifampin gave been responsible for drug-induced hepatitis.

Manifestations of hepatotoxicity include a symptomatic elevation in serum aminotransferase, jaundice and liver tenderness. One recommendation for monitoring for rifampin and pyrazinamide induced hepatitis is to determine the levels of aminotransferase at baseline and at 2, 4 and 6 weeks of treatment and to discontinue rifampin/pyrazinamide when there is (a) serum aminotransferase level that exceeds five times the upper limit of normal in an a symptomatic individual (b) any elevation of serum aminotransferase that accompanied by symptoms of hepatitis (c) any elevation in serum bilirubin (Edward et al., 2004).

The results of this study also match with the results of study carried out by Dossing et al (1996). They observed 61 patients out of 127 patients had elevated aspartate aminiotranferase after the treatment of antituberculous drug. Most of these were men with daily alcohol consumption of 60 g. Hepatitis were confirmed by challenged with pyrazinamide 7 and isoniazid 6 cases.

In the present study, we monitored that occurrence of untoward effects of antituberculous drugs. There was a difference between two studies due to short duration of study and small selected patients. In this study, the cases of hepatitis were recorded more than the study done my Dossing et al.

                This study also matched with the study of Ferner (1990). He observed that ethambutol dose related toxicity. He reported sub clinically impairment of color discrimination relatively common in 54 patients received about 15 mg/Kg/Day of ethambutol as a part of antituberculous therapy. In the present study, the ethambutol produced the opticneurites in high percentage than the Ferner’s study. But similar results were observed in old age patients group who were affected more in both studies. The peripheral neuropathy has been reported in 3 tubercular patients who had receiving the athambutol by 13 to 50 mg/Kg/day.

Peripheral neuropathy was manifested by ethambutol in our study. There were 7 reactions of peripheral neuropathy produced by ethambutol but these reactions were reversible after stoppage of ethambutol.

                In patients prescribed ethambutol it is recommended that after obtaining baseline visual acuity and color perception tests, these tests be repeated every 4 to 6 weeks, especially with new visual symptoms (Chan et, 2004).

                Zinc is found in high concentration in choroids, retina, and ganglion cells and is used by retinal dehydrogenase for transformation of retinal. This last step is important for color vision. Most case of color toxicity are bilateral and result from a dose related retro bulbar optic neuritis that can either axial or peripheral. Axial neuritis involves the papillomacular bundle. It reduces visual acuity and causes central scotomas and color vision deficits. The peripheral visual field deficits but stable visual acuity and color vision (DorothyNahm Friedberg et al.,2004).

                Ellard et al (1976) in their study observed the occurrence of joint pain on a reduction of renal elimination of urate in man caused by administration of pyrazinamide.

                The urinary excretion of pyrazinamide, pyrazinoic acid, 5-hydroxypyrazinoic acid and uric were determined in healthy subjects after giving single or multiple doses of pyrazinamide or its metabolites pyrazinoic acid. The results obtained demonstrated that 5-hydroxypyrazinoic acid is major metabolite of pyrazinoic acid in man and supported previous evidence under that retention of uric acid caused by the administration of pyrazinamide is mediated by pyrazinoic acid. After giving 3 g pyrazinamide the urinary excretion of uric acid was maximally suppressed for 24 hours. Prolonged exposure to pyrazinoic acid resulted in a net reduction in the urinary excretion of uric acid. The finding suggested that the degree of uric acid retention in patients treated with pyrazinamide containing regimens could be reduced by giving pyrazinamide intermittently (Ellard et al., 1976).

This study matched with study conducted by Ellard and coworkers. Pyrazinamide was responsible for joint pain for different age group and gender in the present study. The old age group was commonly affected by pyrazinamide.

                In a study of Hussain et al (2003), ocular reaction and toxic neuropathy were produced by ethambutol in patient’s age between 11 to 80 years. The defected color vision was fouced in 76% of eyes and 27% of eyes had defect in color vision inspite having visual acuity of 6/9 or 6/6. Dilated fundus examination revealed normal optic disc in 66 (67%) of eyes, disc pallor in 27 (28%) of eyes and 4 (4%) eyes had swollen by hyperemic disc.

                The results of present study matched with the results of study conducted by Hussain and coworkers because the ethambutol was effected in the same pathogeneses in old age group.

                Ethambutol is an effective treatment for tuberculosis. It can cause a multitude of dose and time dependent ocular side effects including color changes, visual field defects, and either unilateral or bilateral optic neuritis. Gradual decreases in central visual acuity and green red color vision problem (or less commonly blue yellow color vision defects) have been reported. These defects continue to progress for 1 to 2 months after drug is discontinued (Katherine, 2002).

                This study was also correlated with the study of Mehta (1996). He observed thrombocytopenia in three patients of pulmonary tuberculosis during therapy. Rifampicin was causative drug. The immunological studies in all three patients showed the presence of antiplatelets antibodies reaction resulting in thrombocytopenia.

Moreover, binding of these antibodies to platelet membrane was more avid in presence of rifampicin. In present study, thrombocytopenia was major side effect of rifampin in different age and gender groups. These three patients were separated on the bases of blood complete picture and clinically showed bleeding from nose, petechial rashes and bruises. The pyrazinamide was stopped and it did not reintroduced in these cases.

                Tuberculosis is a granulomatous disease, caused by mycobacterium tuberculosis. As world Health Organization estimates more than 300,000 new cases of tuberculosis develop in Pakistan every year. Cure of infectious cases of tuberculosis is the key to effective control of the disease. Treatment of tuberculosis patients reduces suffering and, if adequately, prevents death from tuberculosis. The first tine of drugs used in the treatment of tuberculosis consists of isoniazid, pyrazinamide, rifampin, streptomycin, and ethambutol. The major side effects are those giving rise to serious health hazards, and require discontinuation of the drug and referral to chest physician. Minor side effects cause relatively little discomfort; they often respond to symptomatic or simple treatment but occasionally persist for the duration of drug treatment. Chemotherapy should be stopped or temporarily interrupted only of severe drug intolerance or toxicity occurs. In fact tuberculosis drugs are relatively toxic and mild side effects are not uncommon but most do not warrant drug withdrawal.

REFERENCES:

A Harries. What are the most common adverse drug events to first line tuberculosis drugs, and what is procedure for reintroduction of drugs. Bulletin of WHO 2004; 154-158.

AD          Harries, NJ Hargreaves, F Gause, JH Kwanjama and FM Salaniponi. “Preventing tuberculosis among health workers in Malawi”. Bulletin of WHO 2002; 526.

Afficial Ammerican Statement. American thoracic society. Treatment of TB and TB infection in adults and children. Am Jr Respiratory Int Car Med 1994; 1359-1374.

Agordon Leitch. “Management of Tuberculosis”, Crofton and Douglas’s Respiratory Disease 5th edition 2000; 444-564.

Agordon Leitch. “Tuberculosis”, Crofton and Douglas’s Respiratory Disease 5th edition, 2000; 476-505.

Alison J Rodger Mice Toole, Babyinuntlvangi, Vmuana and Peter Duts Schmann. “Dots-based tuberculosis treatment and control during civil conflict and HIV epidemic. Church and Pur District, India WHO Bullin 2002; 451-456.

Ann M Ginsberg. What new in TB vaccine? Bulletin of WHO 2002; pp. 483-488.

Arther C Guyton, John D. Pulmonary ventilation In: “Hall Medical Physiology” 10th edition Philadelphia WB Saunder Company 2000; pp.432.

Balasubramanian V CH, Weigeshaus BT Taylor and Smith DW. Pathogeneses of tuberculosis pathway to apical localization. Tubercle and Lung Disease 1994; 75:168-178.

BTS “Adverse reactions to tuberculosis therapy”. Joint Tuberculosis Committee of British Thoracic Society. Thorax 1998; 3:536-548.

Chan KL, Chan HS, Lui SF, Lai KN. Recurrent acute pancreatitis induced by isoniazid. Tubercle and Lung Disease 1994; 75:383-385.

Cheema MA. “Anti Tubercular drugs” Multi author test book of pharmacology and therapeutics” Vol. II, Lahore, National Medical Publication, 2000; pp. 368-370.

Czent. Study of the effect of concomitant food on the bioavability of rifampin. Tubercle and Lung Disease 1995; 76:109-113.

D Marsh, B Hashim, F Hassany and L Hussain. Front line management of pulmonary tuberculosis: analysis of tuberculosis and treatment practices in urban Sindh, Pakistan. Tubercle and Lung Disease 1996; 77:86-92.

David Guwatudde, Sarah Zalwango, Mosses R Kamya, Sara M Debanne, Mireyal J Diaz, Alphonse Okqera, Roy D Muqerova, Charles King and Christopher C Whaten. Burden of tuberculosis in Kampla Uganda. Bulletin of WHO 2003; 799-805.

Dick Menzies. Respiratory epidemiology unit, side effects of common anti-tuberculosis drugs. Am J resp Crit Care Med 2003.

Dorthy Nahm, Friedberg it al. Ocular complications of ethambutol In: Tuberculosis. 2nd Edition. Philadelphia Lipincott William and Wilkins 2004.

Edward D Chan, Celphi Chaterjee, Michael D Iseman. Pyrazinamide, ethambutol, Aminoglycosides 2nd edition, Philadelphia, Lippincott William and Wilkins 2004; 573-589.

Fernandez villar A, Sopina, B Fernandez villar, Luro. Influence of rixk factors on the severity of anti tuberculosis and induced hepatotoxicity. International J Tuber Dis 2004; 8(12):499-505.

Frieden and M Espinal What is the therapeutic effect and what is the toxicity of antituberculosid drug? Toman’s Tuberculosis WHO 2004; 110-121.

GA Ellard and Ruth M hastam. Observation on the reduction of the renal elimination of urate in man caused by the administration of pyrazinamide. Tubercle Lung Dis 1976;57:97-103..

H Turktas, M Unsal, N Tuled, O Uruc. Hepatotoxicity of antituberculous therapy (rifampin, isonizid and pyrazinamide) or viral hepatitis. Tubercle and Lung Disease 1994; 75:58-60.

Henry F, Chambers. “Antimycobacterial drugs”. In: Basic and Clinical Pharmacology, eight edition ,edited by Bertram G Katzung International edition Lame Medical books New York 2001; pp. 803-8114.

Intizar Hussain, Kamran Khalid, M Tayy B. Ocular manifestation of ethambutol toxic optic neuropathy in patients with pulmonary tuberculosis. Pak Postgrad Med J 2003; 14.

M Dossing, JTR Wilikes, DS Askgard, B Liver infury during anti tuberculosis treatment : an 11 year study. Tubercle Lung Dis 1996; 77:335-340.

M Suess. Tuberculosis preventive therapy in HIV infected individuals. Division of communicable disease. Bulletin WHO 1211 Geneva 27, Switzerland 1994.

Martein W Borgdorf. “ Annual risk of tuberculosis infection time for an up date” . Bullentin of WHO 2002; 501-503.

MD isman. What’s in aname… TB or not TB? Tubercle and Lubh Disease 1996; 77:102.

Megan Muray and Edward Nardell. Global epidemiology of tuberculosis: achievements and challenge to current knowledge. Crofton and Douglas’s Respiratory Disease 5th edition, 2004; 80(6):477-483.

Mario C, Raviglione/Richard O’Brain, “Tuberculosis” In: Harrison’s Principles of Internal Medicine, Stephen L, Hauser Dan L. Longo et al . 15th edition vol I, New York MC Graw hill Medical publication division 2001; pp. 1024-35.

      Nizami SQ. Childhood TB. J Pak Med Assoc 1998;48:88.

Ormerod IP and Horfield. N. “Frequency and type of reactions to antituberculosis drugs: observations in routine treatment. Tubercle and Lung Disease 1996; 77:37-42.

Perveen Kumar. Tuberculosis. In: Clinical Medicine 5th edition, Edinburg, WB saunder 2002; pp. 892-897.

PaulNunn, Anthony Harries, PeterGodfrey, Rajgupta, Dermot Maher, Masio Raviglone. The research agenda for improving health, systems performance, and service delivery for tuberculosis control. A WHO perspective World Health Organization 2002; 471-476.

PDO Dawis, DJ uirling and JM Grange. Pulmonary disease IN: Infectious desease 6th edition, Lippincott Williams and Wilkins, Philadelphia 2003; pp. 1644-657.

Pelletier, Yee et al. Incidence of serious side effects from first line antituberculosis drugs among patients treated for active tuberculosis. AJP and Crit care Med 2003.

Philip C Hopwell. Tuberculosis control how the world has changed since 1990. Bulletin of WHO 2002; 427-728.

R Ferner. P. “Ethambutol” New castle upon tyne. Peer Review Strasbourg, France, April 1990.

Richard A Garibaldo, Ronald #E and H Febrebee. Isoniazid associated hepatitis. Am Rev Resp Dis 1972; 1-6:356-367.

Shamim A Qazi, A. KIhan, m. Ak Khan “Epidemiology of childhood of tuberculosis in hospital setting”. J Pak Med Assoc 48:1998.

Tripathi KD. “Antitubercular drugs” In: Essentials of Medical Pharmacology 5th edition, New Dehli, Japee Brothers 2003; pp.698-708.

W Levinson. “Mycobacteria” IN: Medical Microbiology and Immunology. Examination and Board Review 5th edition, New York, Lous Medical Books 200; p.157.

William AP Jr. “Anticicrobial agents” Goodman and Gilmans the Pharmacological bases of therapeutics 10th edition, (Joe1 G Hardman, Ph.D. Lee E. Limbird et a1). McGraw Hill Medical Publishing Division, New York 2001, pp.1273-1295.

YS Mehta EE Jinina, SS Badakere, D M obanty. Rifampin induced ummune thrombocytopenia. Tubercle and lung Disease 1996; 77:558-562.

lalaghulamrasool bhurgri

Traveling is fun and full of excitement. It’s a passion with most people, who like to travel across the globe and see the magnificent plethora of sights and sounds abundant in this fascinating world. These days, with Lowest Tickets, traveling and vacationing in different parts of the world has been made very easy and affordable for most people.

 

The Cheap flight tickets has made it accessible for common man to fly to different beautiful destination in Europe, America, Africa, Australia, Asia and so on. Lowest Tickets has come as a boon for travelers who love to venture into the various parts of the lonely planet. With these Cheap Asia flight tickets, Cheap Africa flight tickets and Cheap Europe flight tickets, life has become very smooth for travelers and for people in general too.

 

Earlier, there was a time when taking a distant flight abroad was like a dream for a common man. Only very rich and affluent people had the luxury of flying across borders. Common people could just dream and nothing else. But, with the changing time, lowest tickets deals has helped budget class people to live their dreams in reality. This has been made possible only because of the innumerable airways and travel companies that have come up these days that provide lowest tickets deals and Business Class Air Tickets.

 

Besides vacationers or leisure travelers, Lowest Tickets has also helped people in general to travel across world for work and for studies too. Unlike old times, people can now think of sending their children across to different destinations for higher studies. Also the young people can easily think of venturing into different field and expand their business or work in any part of the world.

 

Because of the lowest ticket rates, there has been a tremendous increase in the number of travelers to Asia, Africa and even some of the uninhabited island across continents. There is so much to see in the world and the best way to experience anything is to visit the place for your own self. With Lowest Tickets, even the dense forests of Africa and deserts of Sahara are so easily reachable for anyone who wants to visit these places. So, now you can go ahead and enjoy a lavish holiday anywhere with cheap flight tickets.

 

There are many different companies that arrange for lowest tickets deals and provide lucrative travel packages. Along with Business Class Air Tickets for flights, they also offer easy and cheap accommodation facilities. This way, one is free of all the tension of traveling and staying in an unknown or a less known city or any destination. But one has to be careful that before fixing any agency or a package deal, they should confirm the authenticity of the agency and thereby fix the one that offer best rates and most suitable deal. So, now venture into the market and avail the different good offers of cheap flight tickets and have a wonderful time ahead.

 

 

Mike Federer

A map of Egypt easily illustrates why the Sahara Desert is so often called a “sea of sand”. It is enormous and would appear an unwelcome place for a journey, but there are many people who visit the region just to explore the Sahara Desert. Why? Actually the desert is a diverse location full of oases, palm and date groves, hot and cold springs, villages, creatures and remarkable natural wonders.

In order to explore the Sahara Desert safely however, most visitors are encouraged to hire a knowledgeable guide with desert excursion experience. Conditions in the desert are fairly predictable, but someone without the proper equipment and knowledge of the area could easily get lost or into trouble. Luckily there are dozens of companies and travel groups dedicated to serving those who wish to explore the Sahara Desert.

Where should I visit? Many people plan their tour around visits to the five major oases. The farthest and most remote oasis is also one of the most interesting. Near the Libyan border, the Siwa Oasis is an enormous agricultural area which is a major producer of dates and olives. It is also well-known as the location visited by Alexander the Great, where he consulted with the Oracle of Amun in order to confirm his status as the true king of Egypt. Today, Siwa is populated by more than twenty thousand people, mostly Berbers, who live in the many mud-brick houses scattered throughout the area.

Another oasis popular with those who want to explore the Sahara Desert is the Bahariya Oasis. This is a far more modernized oasis than any other, as it is only three hundred kilometers from Cairo and located at the end of a well-made road leading directly out of the city. Visitors today are making the journey in order to watch the exciting and ongoing archeological activity taking place in the oasis. An enormous necropolis was discovered under the sands less than ten years ago, and experts believe over ten thousand mummies are waiting to be found.

Of course anyone who wants to explore the Sahara Desert is not limited to just the oases; there are also many beautiful natural wonders as well. The Farafra Oasis usually hosts visitors who plan to visit the “White Desert” which is a unique area of softer chalk and lime stones that have been worn by the sands and winds into unique shapes and sculptural forms. There is also a distinctive “Black Desert” in this area as well, and most who explore the Sahara Desert make a point of visiting these sites as well as the oases.

Amar Mahallati
http://www.articlesbase.com/destinations-articles/explore-the-sahara-desert-756710.html

 

The Third most populous city in South Africa is Cape Town. The local government is the City of Cape Town it is governed by 210 city council members who report to the 28 member executive council. The mayor is Helen Zille of the Democratic Alliance and she was chosen by the city council.

Robben Island a penitentiary island, which is 10 kilometres out to sea. Nelson Mandela was held here for many years. On his release he made his first public speech from the balcony of Cape Towns City Hall on 11th February 1990. This speech was the beginning of a new era for the country and four years later the first democratic election were held.

The major problems in the city are HIV, Aids, tuberculosis and drug related crimes. There have been murders targeting Somail shopkeepers. The poorer suburbs often have the highest crime rate.

The city has several well known tourist attractions Table Mountain, Table Mountain National Park, City Bowl and Table Mountain Cableway.

Table Mountain is a prominent land mark overlooking Cape town it is a flat top mountain and forms part of Table Mountain National Park. At the top the cable station offers walking trails and a view point. Rock climbing on the mountain is popular.

Table Mountain National Park has two well know landmarks the Cape of Good Hope and Table Mountain. The park was previously known as the Cape Peninsula National Park and is managed by South African National Parks.

The City Bowl is a natural amphitheatre- shaped area bordered by Table Bay. Included in this area is the harbour Devils Peak, the central business district of Cape Town and the Company Gardens.

The Table Mountain Aerial Cableway is one of Cape Towns popular tourist attraction it is a cableway to the top of Table Mountain. From the top cable station you can see views over Cape Town, Robben Island and Table Bay.

The famous Boulders Beach is best know for its colony of African penguins that settled there in 1982.

Beautiful beaches lay between the mountains of the peninsula. Wind surfers and kite surfers go to the west coast beaches where the wind and surfing conditions are good. False Bay beach water is often warmer then the water located on the Atlantic Coast.

The Victoria and Alfred Waterfront is a working harbour and attracts the highest rate of tourists than any other attraction. It offers entertainment and a variety of shopping. The marina houses the luxury apartments and world class hotels.

Douglas Scott
http://www.articlesbase.com/travel-articles/history-of-cape-town-107310.html

 

Technorati Tags: cape town

 

The closest major city to Johannesburg is South Africas capital Pretoria, 58 kilometres to the north a mere hop in your trusty VW t25. The country’s other major city, Cape Town, is 1 400 kilometres south west of Johannesburg. It is in the north of the country. The city is inland from the coast.

The city is a cosmopolitan melting pot with all the conveniences the foreign visitor could want coupled with the unique charms of Africa. It is where the money is and the action is. It is the most powerful commercial centre on the African continent. It is a city that works, literally, the phones dial, the lights switch on, you can drink the water, there are multi lane freeways, skyscrapers, conference centres and golf courses.

There are no mountains to block growth therefore the city is a shapeless sprawl. Johannesburg is 115 years old. It started life as a gold rush shanty town. It was barely in its teens when it sparked an Anglo Boer war that changed southern African history, over a dispute about who controlled Johannesburg.

In less than 30 years the city had outpaced every rival to become southern Africas major commercial centre. For a foreign visitor, it is cheap. In fact an international survey of 22 leading cities found that Johannesburg was the cheapest to live in less than half the price of London and a quarter the price of Tokyo.

Highlights to be seen include some of the following.

Cradle of Humankind is set of caves west of Johannesburg where many experts believe mankinds hominid ancestors first appeared.

Established in 1912, Alexandra is one of the earliest urban black settlements. It is the site of a multi million presidential development initiative.

Botanic Gardens are one of the finest succulent collections, in addition to wide open green spaces, sparkling dams, roses, herbs, birds and trees galore.

Monte Casino Bird Gardens is a new attraction with some 200 species of birds and over 1500 species of small animals. A feature being is the walk in aviary containing 100 species of birds.

The township whose name became synonymous with anti apartheid resistance. On one street, the Tutus once lived.

The jail that held leading activists from Nelson Mandela to Mahatma Gandhi is reborn as the constitutional court and as a museum graves.

A visit to Johannesburgs new Apartheid Museum is a moving experience, you almost feel you were there among the demonstrators facing down the police.

A bus tour takes visitors to sites of intriguing murders in the city.

Take a trip down an old gold mine which even boasts the worlds deepest pub

 

Technorati Tags: commercial centre, johannesburg, vw t25

 

Everywhere, food production is becoming a negative economy, with farmers spending more buying costly inputs for industrial production than the price they receive for their produce. The consequence is rising debts and epidemics of suicides in both rich and poor countries. Cows in the European Union receive on average $2 per day in subsidies. Animals such as chickens are intensively reared rather than allowed to roam free or reared in chicken arks. Over 1 billion people live in the world on less than $1 dollar a day.

Many farmers who traditionally grew pulses and millets and paddy have been lured by seed companies to buy hybrid cotton seeds and other GM crops, which were supposed to make their lives easier and wealthier. Instead they faced bankruptcy and ruin.

Their native seeds have been displaced with new hybrids which cannot be saved and need to be purchased every year at a high cost. Hybrids are also very vulnerable to pest attacks. All pesticides have to be bought from the company that sold them the seeds; there have been reports of blatant profiteering from these companies.

It is experiences such as these which tell me that we are so wrong to be smug about the new global economy. It is time to stop and think about the impact of globalization on the lives of ordinary people. This is vital if we want to achieve sustainability.

We are repeatedly told that without genetic engineering and globalization of agriculture the world will starve, it is constantly promoted as the only alternative available for feeding the hungry.

Farmers in the Third World are encouraged by the IMF and the World Bank to produce cash crops for export. There are usually commodities that can be easily bought and sold on the World Markets. With fluctuating world prices, Fair trade is what can drag farmers and communities out of poverty. In some African countries it is cheaper to buy American sugar and coffee than it is to buy locally produced goods. This is because of over production and subsidies in the West which means that they then dump these goods on Africa destroying local markets.

When patents are granted to companies for seeds and plants, as in the case of basmati, saving and sharing seed is defined as theft of intellectual property. Corporations which have broad patents on crops such as cotton, soya bean and mustard are suing farmers for seed-saving and hiring detective agencies to find out if farmers have saved seed or shared it with neighbours.

As Gandhi reminded us, ‘The Earth has enough for everyone’s needs, but not for some people’s greed.’€

This article has been adapted with the kind permission from Food Patents ‘€”Stealing Indigenous Knowledge’,Anup Shah,2006

Davinos Greeno
http://www.articlesbase.com/politics-articles/globalization-and-poverty-84540.html

 

Technorati Tags: chickenarks, globalization, GM crops

 

Export sector development has become one of the most discussed issues in Sierra Leone’s development politics. The previous administration of Tejan Kabbah introduced some credible initiatives to promote Sierra Leone‒s export trade. The investment code enacted in 2004 could actually increase visibility for Sierra Leone’’ progress in creating an environment conducive to investment and poverty reduction if properly utilized. Empowering SLEDIC (Sierra Leone Export Development and Investment Corporation) as a âone-stop-shop†that simplifies business registration and minimizes transactions cost was also of strategic importance. But years of mismanagement of opportunities stifled the successful implementation of these initiatives. Today, however, there is reason to believe that commitment in implementing export sector development initiatives with the APC-led administration of Ernest Koroma can change.

Vast stretches of arable lands and abundance in mineral resources offer a natural comparative advantage for agricultural and technological development in Sierra Leone. The right commitment, in other words, can greatly square President Koroma’s goal of making government work in Sierra Leone.

The prognosis in Sierra Leone’s politics of self destruction has been hopelessly grim for decades. The country has consistently suffered decades of severe economic hardship and struggling with chronic problems of corruption and a broken management system at national proportions. The Gross Domestic Product (GDP) has not looked good for decades and the country has consistently ranked very low in the United Nations’ assessments of countries’ human development indices. It might make sense for the new APC administration to be serious about government, commit to a selfless agenda of national development, and expect the best to come out of Sierra Leone. But the commitment to change the pervading prognosis of systematic mismanagement of resources can even be now much more promising than it has been since the APC is being given a second chance, and President Koroma living up to the high standard of expectations Sierra Leoneans have for his government. Apparently, Sierra Leoneans have lost every patience and all they want to see is a government that can build on a pattern of positive change for sustained development.

The last one year Koroma has been in power has brought major changes in the underlying strategic calculus facing Sierra Leone’s governance system – an ACC made stronger, emphasis on performance and fiscal responsibility in public office, and creating new, more positive development dynamics and incentives. And these developments can be made sustainable with the vast potential in agricultural and technological development. Insisting on excellence in public service and emphasis in export sector development initiatives developed within the framework of the trade agreements and the WTO trade rules that apply to international trade will work under the new conditions in Sierra Leone. President Koroma has shown praiseworthy commitment to “unite both the private and public sectors for a well-ordered society and economic progress”, a position made clear at a private sector forum at the British Council which State House convened in conjunction with the Sierra Leone Business Forum”. However, the laudable efforts of the president require a sustained commitment that supports a liberalized trading system to promote trade and diversify exports.

Both to build on the export sector development initiatives started by Kabbah and to introduce new dynamics, any commitment to good governance, now that the mechanisms of democracy are in place, should be reassuring and taken seriously.

Enabling Environment

Most countries have a mental image of Sierra Leone that is defined by the chaos of a society overrun by corrupt politicians and business people. But Sierra Leone can be made a very different place than for what it was known. Overall development can make paramount the pursuit of accountable, transparent and corruption-free policies to ensure a carefully sequenced opening up of investment opportunities in the country. The effort towards establishing mutual recognition agreements for agricultural exports with other market countries can greatly impact Sierra Leone’s export development sector. The Ministries of Agriculture, Marine Resources, Mineral Resources, Foreign Affairs, Trade and SLEDIC have a role to play. They have to create the environment to attract major investments to develop Sierra Leone’s cottage industries and raise the quality of products made in Sierra Leone. There are certain things the government can also do such as:

· identify and enhance divestiture of state-owned enterprises;

· augment the liberalization of trade and exchange rate, deregulation of prices, strengthening of fiscal management and domestic resource mobilization, and elimination of subsidies (especially on petroleum products and the staple food, rice);

· streamline and facilitate the process for exports by eliminating duplication and ensuring coordination between Government provided services to the export industry; and

· sustained support to the agricultural sector.

In the same token, small and medium-sized enterprises are key drivers of the economy. Helping them to develop is a reaffirmation of the fundamentals of trade sector development which include the establishment of export processing zone, provision of micro finance, and reactivation of skills training centers.

These are remarkable trends that are in sync with trends in facilitating the development of value added products for accessing markets in the United States and Europe through the United States African Growth and Opportunity Act (AGOA) and the European Union’s Everything But Arms (EBA) Initiatives; and formulating transparent investment guidelines.

Sustainable rural development programs that support supply side resources available for export which are in the rural sector and the development of these resources shall also see benefits occur in the development of viable income for the rural sector. The government’s role in facilitating development of the infrastructure for clean water, healthcare, roads, electricity and telecommunications is critical. The European Union, the World Bank and other international development agencies are partners in development for Sierra Leone. The government has to show a sustained responsibility and commitment to cooperate with these world institutions.

Export sector development, and especially its emphasis on enabling investment opportunities for the development of small and medium enterprises and raising standards in product development, will enable the growth of the Sierra Leone economy. Agriculture, combined with financial resources generated from the country’s vast mineral resource base and a strong export sector development knowledge of what standards are required to compete in the global market, will essentially drive Sierra Leone’s engine of growth.

Essentially also, access to information is fundamental to the development of a viable private sector. The private sector needs to know what is out there and how to capitalize on the market access agreements available. To reaffirm its responsibility and commitment, the Government needs to leverage technology to make available such information. A combination of business training and development programs and the one-stop approach to ensuring coherence in private sector development shall result in the sustainability of available resources.

Further, agriculture and fisheries are areas if enabled can quickly develop an export led economy. The APC-led administration seems to recognize this. A successful example of this is the boost in fishery exports since last year when the APC was voted in. The Ministry of Marine Resources (one of the country’s highest employers with over 100,000 employees for those in marketing and processing marine resources and 30,000 employees for local fishing communities) generated Le1,196.42 billion from October to November 2007; Le1.2 billion in December 2007 and Le1.7 billion in January, 2008. In spite of the persistent pirating by fishing vessels traversing Sierra Leone’s territorial waters, the Ministry has managed to conserve the country’s marine resources and to avoid depletion that has seen stable profitable growth in the sector.

A national export strategy (NES) can be fully developed as part of the Ministry of Finance budget information. Government can support the aggressive expansion of the availability of financing for export development and to assist in the development of standards and regulations of the services sector to provide a base for the export of this sector of the economy. Consistent with what the APC-led administration of Ernest Koroma is trying to do, government should do more to strengthen public-private partnerships and ensure it is never taken for granted.

The private sector can feel appreciated when government can ensure the participation of the private sector in high-level diplomatic missions, assisting companies in accessing trade shows and markets internationally. The ability to access distribution channels for exporters cannot be over-stated as high level missions can open doors that the individual companies cannot open. The opportunity to gain exposure in overseas markets is an underutilized initiative and needs to be strengthened.

Moreover, developing a database/register of customary land based on clear standards of ownership of land is also fundamental to Sierra Leone’s export economy. The net result of all this would be a profound change in the underlying strategic calculus in the APC administration’s commitment to drive economic development in Sierra Leone – building on the essence of an export-led economy which creates jobs and promotes a stable and progressively developing Sierra Leone.  It is worth noting that a combination of initiatives to drive an export-led economy is chief driver of sustained economic development. Much of the country’s GDP remains underutilized but shows great potential. And whereas an export-led economy argument implies that GDP increases are realized, a national export strategy that encompasses all the initiatives of the previous administration and evolving new ideas can be fully integrated in a well articulated national export strategy.

Supply Side Potential

If the APC administration and its leaders are to keep Sierra Leone moving toward economic stability, they must still overcome a range of supply-specific challenges that need to be developed to meet the standards of the global market. These challenges promise to be generally less daunting with the right leadership resolve to drive change, and where resolve is lacking they could still make worse the severe economic woes of the country. Sierra Leone may still rank last in the United Nations Human Development Index (HDI), but as, Dmitry Titov, Assistant Secretary-General of the Department of Peacekeeping Operations (DPKO) puts it, Sierra Leone’s prospects of moving forward and boosting its socio-economic situation is ‘hopeful” (Scoop World Independent News). Achieving this, however, will be the responsibility of the country’s leadership to guide an export-sector-led economy and to develop such economy to meet the standards of the global market. There are a good number of supply-specific areas that can be developed, but it is worth highlighting some of the most important.

First, there is the challenge of developing the country cloth and garments market. This is possible with a garment training center or other body established with industry standards either established through SLEDIC or the Ministry of Trade. The possibilities of a garment training center should be a critical element in growing the garment industry in Sierra Leone. With major production enhanced, the need can be simultaneously created to support fashion or trade shows and a greater interaction between the hospitality industry and the garment industry.

Sierra Leone obtained the AGOA Visa for textiles and garments in April 2004 and that should be an excellent tool for exploring export opportunities available as well as through other initiatives such as those afforded through the European Union-African Caribbean and Pacific (EU-ACP) cooperation, World Trade Organization and the economic Community of West African States (ECOWAS). A Standards Bureau can help in implementing standards and quality control measures to make Sierra Leonean products competitive.

The Agriculture and Agro-Processing industry is also with great possibilities if it can overcome sanitary, bio-security and technical barriers to trade. Proper agro-processing adds value in the local environment and achieves a market ready product for immediate distribution or sale reducing offshore costs and maximizing returns. Standardized agro-processing facility can assist rural communities by providing a local base for their exports. SLEDIC should provide guidelines on sustainable processing for better market access and should come up with a quality mark for all Sierra Leonean agro-processed products. Identifying tropical products which have combined high returns to the farmer by either having high yield or high returns has the potential of giving farmers the options to look at more innovative plants that can form a basis for value adding.

Catalyst large farms can provide consistent volumes that can then be used to coalesce the many small community landholdings into a reliable consistent sustainable supplier of produce. More active pest eradication and assessment programs are necessary to build faith in agricultural supplies from Sierra Leone. Also looking at organic farming as a future for Sierra Leone and as a niche market with high value with government providing certification will have an added virtue of sparking an agricultural boom and thereby helping reduce unemployment. And with standards provided for the output of agricultural products, farmers and exporters would clearly understand the export needs of the different markets.

Effectively managed agricultural support measures such as the provision of machinery and improved seedlings to farmers and farming communities is expected to help not only in achieving Government’s goal of food security but also encouraging crop diversification for both domestic consumption and export. With support from partners notably UNDP, FAO and the ADB considerable improvement has been made in the agricultural sector with the establishment of more than 130,000 Agricultural Business Units (ABUs) in the rural areas that account for the anticipated increase in agricultural production. These are existing facilities that can be further developed and adequately utilized.

Value adding through drying or smoking as well as packaging should be a priority for the fishing industry as another export sector development possibility. Facilities to handle fishing vessels need upgrade and aquaculture practices developed to meet global standards in fisheries development.

Credible policy reforms in the mining sector are important for sustaining improved minerals production. Modern mining operations require substantial investments. The ability of existing indigenous operators to modernize their operations depends on the availability of foreign investments to acquire the necessary hardware and expertise. What could be done is to promote the effective organization of cooperative joint ventures with owners of diamondiferous lands whose lands could be used as collaterals to secure the foreign direct investments and/or lines of credit needed to acquire modern mining equipment like bulldozers, excavators, front-end loaders, draglines, etc.

Further, setting up of diamond cutting and polishing stations equipped with workbenches designed for use with diamond cutting fly wheels along with several grinding applications is necessary. Diamond cutting is the art, skill and, increasingly, science of changing a diamond from a rough stone into a faceted gem. Diamond cutting requires specialized knowledge, tools, equipment, and techniques because of its extreme hardness. The history of diamond cutting and polishing has its origins in India, where it was discovered a long time ago by Indian lapidaries that a diamond could be made to glisten simply by grinding another diamond against it. The setting up of these diamond cutting and polishing stations in Sierra Leone will aid the local diamond trade. The goal is to import diamond polishing skills and technology to Sierra Leone to enable the country to compete with other countries like the United States and India in the diamond processing sector. The Government of Sierra Leone should applaud this initiative since it is emphasizing the need for indigenous Sierra Leoneans to share in the downstream benefit of diamonds.

A final export sector development strategy worth noting is the services sector. At present the country does not have a well supported and regulated consultancy sector which could form the bulk of exports in the services sector. The only sector recognized is the Tourism sector which although important is not the only services sector with opportunities. Sierra Leone shows great potential in a number of areas and this expertise is yet to be developed using Government assistance and there should be an export focus on these areas.

Efficient Production Practices

Firms in Sierra Leone are often unaware of their own inefficiency. Such firms attribute too much of their inability to export to external factors and too little to their lack of efficient production. Import restrictions creating protected domestic markets have given entrepreneurs a false sense of competence. These entrepreneurs are only slowly aware of the critical roles that quality control, price and on-time delivery plays in international markets. Once their eyes are opened to the importance of these factors, access to buyers and technical support focused on production constraints can provide them with the means for lowering costs and raising quality.

Filling in specific service gaps can speed up the private sector response to policy improvements, and can accelerate export growth. With more knowledge and contacts, firms will achieve a higher level of export sales and more firms will enter the market. In short, intervention in the market for export services can be justified based on “infant industry” and “learning by doing” considerations.

Finally, the institutional structure of the export support service entity must fit the type of service provided. Membership-based trade groups, such as exporters associations, have been effective in providing basic information on buyers and foreign markets. But private non-profits or freestanding projects have been more effective in providing customized, firm-specific services. The point is that they often have the autonomy, expertise and flexibility to link firms with appropriate commercial sources of services, such as buyers, suppliers, and investors.

Of course, much could be done by utter commitment of the leaders who should understand and accept the importance of private sector input in the formulation of government trade and general economic policies. The potential of the global marketplace as a source of corporate expansion and economic growth is great. The policy makers have the sublime role to support private companies in seizing the opportunities that an integrated world economy offers - access to foreign capital, new market opportunities and increased trade. A Trade Policy Review with the support of the World Trade Organization (WTO), substantial deregulation to boost investment and private sector development, will yield a stability that endures as Sierra Leone economic growth is defined.

Credit: Cocorioko Sierra Leone Portal

Kenday S. Kamara
http://www.articlesbase.com/business-opportunities-articles/sierra-leone-building-on-an-exportsectorled-economy-589806.html

 

Technorati Tags: sierra leone

 

Environmental problems are key challenges of the XXIst century. The terrestrial, freshwater and marine environments have declined in virtually all aspects. New developments in industry and manufacturing were root causes of environmental degradation over the past three decades. The rapid growth of population, urbanization and globalization are the driving force of the environmental problems. However, the challenge is extremely high not only for the well-developed regions, but in poor parts of the world as well. The challenges have to be dealt with at the micro environemt of the chicken ark keeping village, right through to the macro envronment of gross resource exploitation

Such environmental problems as land degradation, deforestation, declining of marine resources and water scarcity of deteriorating of water and air quality are on the priority list in Africa. Despite, Africa possesses wealthy natural resources many Africans live in poverty unable to benefit from the African wealth because of uneven distribution across the continent and partly because of African complicated history over the past 50 years after the decolonization.

Africa has a vast majority of poor states and regions, and poverty is a major reason and consequence of the environmental degradation. The present paper ascertains the small research on the environmental issues in Africa. In the work I will analyze one Africa region, demonstrating its problems in the environment. At the end I will point out the root cause of these problems and suggest possible ways out, if there are any.

In general a vast majority of countries in Africa depend more on their natural resource base for economic and social needs than any other region in the world. Thus, two-thirds of sub-Saharan Africa’s people live in rural areas and rely on agriculture and other natural resources for income. Sub-Saharan states of Africa are right the countries, where environmental problems are first on the agenda. The environmental problems have already waited a long time for their turn. Among them there are air and water pollution, inefficient use of natural resources, oil spills and so on. Environmental problems of sub-Saharan Africa also include air and water pollution, deforestation, loss of soil and soil fertility, and a dramatic decline in biodiversity throughout the region. nest paragraphs will face the problems in more details.
It is quite understandable that the environmental problems in Sub-Sahar region are crucial and severe. The most compelling problem in Sub-Saharan Africa is that it has one of the world’s fastest growing populations (approximately 2.2% a year). With the fast grow of the population the environmental challenge increase. By the year 2025 according to some estimation, the population of the African people will be over a billion. This means that the environmental challenges will definitely double or triple. Some literature indicate that Sub-African countries managed to perform more effective economic policies, which influenced the development in the region in general, but GDP growth has stagnated recently and it is obvious that with the stagnation of the economics will cause decrease in the solution of the ecological challenges.
Poverty also is the main factor that influences the development of the environmental issues. And it also exists in Sub-Sahar region, despite the region is not that poor in the comparison with other regions in Africa and in spite of the wealth natural resources. In general the problems in sub-Sahar and in Africa in common was addressed during the World Summit on sustainable Development (WSSD) which was help in South Africa in August 2002. Basically, the material of the summit points out main environmental problems and challenges. The key issues which dominate African environmental problems were addressed during the summit. They include:

1. Water pollution and sanitation. First of all water pollution is caused by oil transmission n ship ports, water resources poor management, lack of financial resources required for sustainable development and efficient utilization of resources, absence of effective regional and basin development plans and shared management, and under-estimation of the groundwater potential to supplement irrigation and drinking water supplies. Thus, Africa’s freshwater problems are acute and worsening. Freshwater shortage is the two greatest limits to development in Africa;

2. Energy. Energy consumption in sub-Saharan Africa varies dramatically and dominates fuel consumption. According to reports the use of wood for fuel is predominant in both rural and urban locations and accounts for approximately 70% of total energy use. This cause another problem deforestation. In Sub-Sahara region Nigeria consistently leads to commercial energy consumption. Thus, according to data in 2001, Nigeria consumed 0.92 quadrillion Btu (quads), 32% of all energy consumed in the region. Although domestic demand for energy consumption in sub-Saharan Africa is growing rapidly, consumption levels remain well below world averages. I would like to mention but few words about deforestation. Africa is home to one of the world’s largest rain forests.

It is obvious that rain forests are lungs of the Earth and their reduction cause air pollution. They protect and stabilize soils, recycle nutrients and regulate the quality and flow of water. Deforestation is one of the most pressing environmental problems not only in Africa but in other parts of the world and has negative implications for the local and global environment. Forests cover about 22 per cent of the region, but they are disappearing faster than anywhere else in the developing world. During the 1980s Africa lost 10.5 per cent of its forests. Thus, African forests are shrinking as a result of deforestation;

3. Deforestation causes another problem - threats to biodiversity. The richness of African biodiversity requires greater protection and a sustainable use that will ensure the income of those who depend on it. There is a need to maximize biodiversity landscape protection, to give priority to biodiversity areas close to areas of high population density, and to give balanced attention to such regions as the arid and semi-arid areas.

4. Oil pollution. Oil pollution is one of the issues that must be specified being a controversial subject of heated discussion among the representatives of the academia. In a number of countries such as Nigeria and Angola, fore example, oil is the principle source of benefits. However it is pretty clear that new technologies used in oil exploration are extremely harmful for the environment. Environmental problems are common and rise heated debates. On the one hand, it expands relations among states, diversify trade relations, bring benefits. But, on the other hand, the benefits from oil are not fairly distributed among the population. The revenues from oil mainly belong to some local government communities or certain groups of interest. But the commons of Sub-Sahara have to face the oil-related problems.

Increased food insecurity resulting from rapid population growth, degradation of agriculture and arable lands, and mismanagement of available water resources combined with poor economic policies to support food production. Land degradation is also a serious environmental problem. However, Africa owns vast areas of unexploited arable land which could be exploited in the future through the integrated management of land, water and human resources.

After the Summit was held sub-Saharan Africa many problems were clear. To summarize, the address of environmental issues first of all lie in environmental awareness. But what was done to address the challenges? First, many problems in this region received more attention than in past and The United States pledged $4.5 billion over the next three years to combat HIV/AIDS and improve access to safe water. Many projects were launched by international organizations and NGOs in order to promote forest conservation. European Union was also involved in the process of combating the issues and helped in brining water and sanitation services. These events were helpful but did not solve the whole spectrum of problems.

it is clear that external participation is not obviously enough in addressing complicated problems. It is understandable that local governments have to work hard on solutions. The environmental problems that were addressed in the paper are not unique and can be found in many regions of our planet, especially where poverty flourish. But not only poverty is the decisive factor in pollution. Russia, for example is the state which suffers from the water and air pollution caused by nuclear developments. The problem was not resolved completely as Russia does not want to cease the development of nuclear infrastructure, but it was addressed at least party.

It is important to notice that a vast majority of states face environmental issues and problems, they may vary from region to region, but in general almost every region on this planet where urbanization or globalization takes place is a subject to environmental problems. Moreover, environmental issues may vary from one region to another, but still may have an impact upon different sphere of economics or social spheres. To cap it all the environmental issues need regular monitoring, assessments and public reports of the state.

Water pollution is one of the examples of growing global awareness and efforts made to combat the issue. It must be noticed that the environmental impacts associated with oil exploration and development was the controversy surrounding the World Bank’s approval of the Chad-Cameroon Pipeline Project in June 2000.

The summit, which was held on Sub-Sahara issues drew the attention of a number of developing states and the world hegemony the United States as well as regional or international organizations. The awareness of the problems made these entities to collaborate on the issue.

The increase of problems awareness influenced also the attention of local governments. But it is clear that some states of Africa because of their poverty undoubtedly need the interference of stronger states in the resolution of the problems. It was stated at the beginning of the paper that environmental problems are rather new and some of them are not more that 10 or 20 year old.

To some extent they were caused by globalization and urbanization. Thus, is they are caused by global inadequate levels of population grow and demands for more water and oil, then the burden of their resolution is also global. It is true that the increase in environmental awareness made people more persistent in the demands toward local governments. But the forceful demands are not enough, as significant regions in Africa are poor and suffer from poverty issue. This means that it is important to increase environmental awareness within the general public, but because of poverty it can not lead sometimes to strong and necessary changes.

Hence, the key challenge for Sub-African region is to reduce poverty. New approaches must be found and it is important to organize investment in climate studies. Establishing a positive investment climate in Africa is increasingly important to face the environmental problems in the regions, which are only involved in oil production.

Andrew Sandon
http://www.articlesbase.com/environment-articles/environmental-problems-in-africa-67595.html

 

Technorati Tags: climate changes, deforestation, natural resources

 

Water raises national fervor in Canada, and Canadians are reluctant to share their birthright with a United States that has mismanaged? Indeed, the prospect of losing control of its water under free-trade or other agreements is something Canadians seem to worry about constantly.

Water is having a significant impact on many people’s lives around the world. From droughts to quake lakes, floods to monsoons, people and animals are dealing with water in many ways.

Water reserves have become scarce in many African countries, such as Chad, due mainly to global climate change. As lakes shrink, the local population loses its means of survival, sowing the seeds for violence between communities.  This is a matter of survival for alrge numbers of people in sub-saharan africa where thei lack of water has led to the inability of populations to systain even the most basic agrculture.  Cattle, which need large quantities of water, often die.  Goats strip the remaining sparse vegetation and even keeping chickens is becoming dfficult across large areas. 

Water consumption is doubling every 20 years and yet at the same time, water sources are rapidly being polluted, depleted, diverted and exploited by corporate interests ranging from industrial agriculture and manufacturing to electricity production and mining.

The World Bank predicts that by 2025, two-thirds of the world’s population will suffer from lack of clean and safe drinking water.

Water molecules are naturally attracted and stick to each other because of this polarity, forming a hydrogen bond . This hydrogen bond is the reason behind many of water’s special properties, such as the fact that it’s denser in its liquid state than in its solid state (ice floats on water).

Water use doesn’t just include what you drink from the bottle or what you use to wash your clothes. It also includes the water used to grow the things we eat and wear. Water, of course, is essential to human health. Drinking enough water to replace whatever is lost through bodily functions is important. Water can be liquid, solid, or gas. It can evaporate into vapor or freeze into ice.

Water makes up more than half of your body weight and a person can’t survive for more than a few days without it. Your body has lots of important jobs and it needs water to do many of them. Water quality can be compromised by the presence of infectious agents, toxic chemicals, and radiological hazards. Water stress results from an imbalance between water use and water resources. The water stress indicator in this map measures the proportion of water withdrawal with respect to total renewable resources.

Clean water is vital to life and its supply is limited, so it must be utilized carefully to be sure it is protected for future generations. API and our members work to ensure the continued availability of high quality water. Clean water can be easy to take for granted. Flowing in and out of our homes and businesses through underground pipes, clean water for sanitation keeps our communities livable, our lifestyles possible, and our industries viable.

 

Technorati Tags: sub saharan africa, water shortages