ObjectiveTo determine risk factors for anaemia in preschool children.DesignA cross-sectional study.SettingTigray province, northern Ethiopia.Subjects2080 of 2373 children aged 6–60 months provided blood to assess anaemia.ResultsAnaemia was highly prevalent (42%) and constituted an important nutritional problem in the region. In a sub-sample of 230 anaemic children, 56% had a low red blood cell (RBC) count, and 43% had a serum ferritin of less than 12 μg l−1 indicating that the anaemia was largely due to iron deficiency. Unlike other regions in developing countries, hookworm (0.4%) and malaria (0.0%) were rare and contributed little to the anaemia. Even though their diet lacked variety, the amount of iron consumed through cereal-based staple foods was adequate. However, the iron in these foods was not readily available and their diets were probably high in iron absorption inhibitors and low in enhancers. Dietary factors associated with anaemia included frequent consumption of inhibitors, such as fenugreek and coffee, and poor health in the child such as diarrhoea and stunting.ConclusionsUnderlying causes of anaemia were lack of safe water and inadequate human waste management, maternal illiteracy and mother being ill, and having no food reserves. The root cause of these factors was poverty. The optimal control strategy for iron deficiency anaemia should have a holistic approach which includes the alleviation of poverty, the empowerment of women and the provision of a safe environment.

Changes in temperature (from room temperature to 50 degrees C) and staining time (from 90 to 10 min) were evaluated as a means of improving the detection of microsporidia from stool specimens. A blinded and independent comparison of 50 known positive matched-specimen pairs by three technologists resulted in consistently easier microscopic detection. The background is clearer, and spores stain more intensely. Staining time is reduced by 80 min.

Stool microscopy as performed in clinical parasitology laboratories is a complex procedure with subjective interpretation. Quality assurance (QA) programs often emphasize proficiency testing as an assessment tool. We describe a result reproducibility assessment tool, which can form part of a broader QA program, and which is based on the blinded resubmission of selected clinical samples, using concordance between the reports of the initial and resubmitted specimen as an indicator. Specimens preserved in sodium acetate-acetic acid-formalin can be stored for several months for use in such a program. The presence of multiple protozoa in one specimen does not affect concordance. Some dilution of specimens occurs in this process, and this may explain poor concordance when specimens with low protozoal concentrations are resubmitted. Evaluation of this tool in a large parasitology laboratory revealed concordance rates for pathogenic protozoa (Entamoeba histolytica/Entamoeba dispar, Giardia lamblia, and Dientamoeba fragilis) of about 80%, which may be considered for use as a benchmark value. We also used this tool to demonstrate that when pairs of specimens from one patient are pooled to create a single specimen, concordance between the results of the individual and pooled specimens is high.Clinical parasitology laboratories, in contrast to most other diagnostic laboratories, utilize many complex manual technical procedures which are subject to individual variation and subjective interpretations (8). As a result, quality assurance (QA) programs are crucial for maintaining confidence in the accuracy of test results. Meaningful QA programs can be difficult to design and expensive to implement. In addition, indicators of diagnostic accuracy can be difficult to assess given the inherent variability among testing procedures (19) and technologists (11). Therefore, not only does the routine testing of stool specimens for intestinal protozoa by microscopy remain a challenge for the modern diagnostic laboratory (3, 19), but so does the assessment of the accuracy of this testing.To date, no studies have been published on the value of a QA program undertaken to directly evaluate the quality of microscopy in the detection of intestinal protozoa, although several have reviewed this for other types of procedures and microorganisms (e.g., bacterial counts [2]; human immunodeficiency virus [4]). QA programs, such as that undertaken by the College of American Pathologists, have typically relied on results from proficiency tests (17). In some areas of clinical microbiology, proficiency testing has been used to evaluate multiple steps in a complex process and reveal widespread systematic problems (e.g., for Streptococcus pneumoniae antimicrobial susceptibility testing [5]). In the parasitology laboratory, proficiency tests are based on sending "unknowns" to each participating laboratory, and the evaluation is based on the number of parasite species correctly identified. A potential weakness of proficiency testing is the possibility for the...