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Artificial water channels (AWCs) have emerged as a promising framework for stable water permeation, with water transport rates comparable to aquaporins (3.4-40.3 × 10 8 H 2 O/channel/s). In this study, we probe the influence of ring-size and side-chain length on the water permeability observed within a class of AWCs termed ligand-appended pillar[n]arenes (LAPs) that have an adjustable ring-size ( m ) and side-chain length ( n ). Through all-atom molecular dynamics simulations, we calculate the permeability of these channels using the collective diffusion model and find their permeabilities. We characterize the mechanistic influence of pillar[n]arene ring-size and side-chain length on the channel water permeability by analyzing the characteristics of the internal permeating water-wire and the surrounding channel structure. We observe that water permeability decreases as a function of increasing ring-size due to increases in hydrophilic contacts between the permeating water-wire and the oxygen groups on the channel wall. Further, we observe an increase in water permeability as a function of side-chain length due to increased partitioning of the channel terminal groups into the hydrophilic blocks of the surrounding bilayer. For the LAP6 channel, with increase in side-chain length, the distance between terminal groups increases and leads to an increase in pore size, thereby enhancing water permeability. In the case of LAP5, as side-chain length increases, the channel displays a compensatory effect between tilt and bend angle due to the flexible side-chains. Such flexibility leads to higher terminal group partitioning in the hydrophilic blocks of the bilayer and extends the permeating water-wire. This increase in water-wire length and hydrophilic block access overcomes the nonmonotonic pore size trend in pillar[5]arene channels.

Introduction: Trachoma is caused by the bacterium Chlamydia trachomatis ( Ct ). The WHO recommends the SAFE strategy for trachoma elimination: Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement. Multiple rounds of SAFE implementation have proven insufficient to eliminate trachoma in Ethiopia, where over 50% of the global trachoma burden remains. More effective antibiotic treatment schedules and transmission-suppressing approaches are needed. The aim of stronger SAFE is to evaluate the impact of a novel package of interventions to strengthen the A, F and E of SAFE on the prevalence of ocular Ct and trachoma in Oromia, Ethiopia., Methods and Analysis: 68 clusters were randomised in a 1:1:1:1 ratio to one of (1) standard A/standard F&E (standard SAFE), (2) standard A/enhanced F&E, (3) enhanced A/standard F&E or (4) enhanced A/enhanced F&E (stronger SAFE). Enhanced A includes two height-based doses of oral azithromycin (equivalent to 20 mg/kg) given as single doses 2 weeks apart, as mass drug administration, annually. Enhanced F&E includes fly control measures (permethrin-treated headwear and odour-baited traps) and face-washing hygiene behaviour change implemented at household level in selected communities. The interventions will be implemented and reinforced over 3 years.The primary outcome is the prevalence of ocular Ct by quantitative PCR in children aged 1-9 years at 36 months. A key secondary outcome is the prevalence of active (inflammatory) trachoma in the same children, assessed by validated trachoma graders and conjunctival photography. Laboratory technicians and photo-graders are masked to treatment allocation. Other important secondary analyses include process evaluations, assessment of behaviour change, fly indicators, adherence and coverage of interventions and a cost analysis., Ethics and Dissemination: Study protocols have been approved by the National Research Ethics Review Committee of the Ethiopian Ministry of Science and Higher Education and the London School of Hygiene & Tropical Medicine Ethics Committee. An independent data safety and monitoring board oversees the trial. Results will be disseminated through peer-reviewed publications, presentations and reports., Trial Registration Number: ISRCTN40760473., Competing Interests: Competing interests: None declared., (© World Health Organization 2024. Licensee BMJ.)

The increasing amount of municipal organic waste (MOW) and human excreta (HE) has led to socio-economic and environmental challenges in the cities of developing countries. This study estimated MOW and HE, compost production potential from MOW and HE, and compost application potential for urban agriculture fertilization, economic benefits, soil carbon sequestration, and greenhouse gas (GHG) mitigation in Addis Ababa, Ethiopia, for the period 2025-2050. MOW was forecasted using the Holt-Winters forecasting model. HE was estimated using the daily average rate of HE generation. The compost production potential was estimated using the forecasted MOW and HE. Compost fertilization was determined by considering compost nitrogen (N), phosphorus (P), and potassium (K) and the fertilizer requirements of cereals and vegetables. The economic benefits of compost were determined by considering the price of compost-equivalent urea, NPS, and potassium chloride fertilizers. The mitigation of GHG emissions from compost application was estimated using the IPCC Tier 1 method. The forecasted quantities of MOW, HE, and compost for 2050 are 301, 462, and 343 Gg, respectively. The compost could supply 5 Gg of N and 2.2 Gg of P in 2050, sufficient to fertilize 14,129 ha of vegetable fields. The economic benefits of using compost as a substitute for synthetic fertilizers could reach 10 million USD in 2050. Compost production and application could offset the total GHG emissions of Addis Ababa by 13.1 % (10,241Gg CO 2 -eq year -1 ) in 2050. The application of compost generated from MOW and HE in Addis Ababa can substitute synthetic fertilizers, provide economic benefits, and mitigate GHG emissions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dong-Gill Kim reports financial support was provided by DAAD. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Treatment of rifampicin-resistant or multidrug-resistant tuberculosis (RR/MDR-TB) requires the use of second-line anti-TB drugs, which are less effective and more toxic. This study assessed treatment outcomes and factors associated with unfavorable treatment outcomes among RR/MDR-TB patients in Southwestern Oromia, Ethiopia., Methods: A multicenter retrospective study was conducted on 226 RR/MDR-TB patients (six extrapulmonary and 220 pulmonary) treated under a national TB program between 2013 and 2022 at five treatment facilities in Southwestern Oromia, Ethiopia. RR/MDR-TB patient data, such as sociodemographic, clinical, and laboratory results and treatment outcomes, were collected from the RR/MDR-TB registry using a standard data extraction form between April and June 2023. Logistic regression analysis was used to explore the associations between risk factors and unfavorable treatment outcomes., Results: Among 220 pulmonary RR/MDR-TB patients, 181 (82.3%) achieved favorable treatment outcomes (161 cured and 20 treatment completed). However, 39 (17.7%) patients had unfavorable treatment outcomes (12 were lost to follow-up, seven experienced treatment failure, and 20 died). Of the six extrapulmonary RR/MDR-TB patients, five (83.3%) had favorable treatment outcomes, and one (16.7%) was lost to follow-up. Pulmonary RR/MDR-TB patients with HIV infection (AOR = 4.85, 95% CI: 1.90 to 12.39), history of previous TB treatment (AOR = 3.09, 95% CI: 1.21 to 7.86), and low baseline BMI (AOR = 2.86, 95% CI: 1.06 to 7.72) had increased risk of unfavorable treatment outcomes., Conclusion: Although the majority of RR/MDR-TB patients have favorable treatment outcomes, a significant proportion of patients still experienced unfavorable outcomes. Patients with HIV infection, history of previous TB treatment, and low baseline BMI require special attention to improve pulmonary RR/MDR-TB treatment outcomes. Future studies with larger sample sizes are required to evaluate treatment outcomes and associated factors among patients with extrapulmonary RR/MDR-TB., Competing Interests: Declarations Ethical approval and consent to Participate The study was performed following the principles stated in the Declaration of Helsinki. The Institutional Review Board (IRB) at the Institute of Health, Jimma University, Ethiopia, approved the study protocol (Reference No. IHRPG/169/21) and waived the requirement for informed consent due to the retrospective nature of the study design. To ensure the privacy and confidentiality of the study participants, the data were deidentified and securely stored in locked cabinets. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Soil degradation affects its quality and productivity of the land. To control soil degradation, various soil and water conservation (SWC) measures, including area closure are implemented. Understanding the impacts of SWC measures could support planning and implementation of land management practices. This study aimed to investigate impacts of area closure on soil properties in south central highland of Ethiopia. To acquire the necessary data, we conducted interviews with 80 households. Furthermore, nine years old area closure with physical soil and water conservation (AC-SWC), open grazing with physical SWC (OG-SWC), and open grazing without physical SWC (OG) were identified and each divided into upper, middle, and lower slope positions. In each slope position, 3 sample plots were established at 25-50 m intervals. A total of 27 composite samples and other 27 core samples for bulk density (3 treatments∗3 slope position∗3 replications) were collected and analyzed for soil properties. The data were analyzed using descriptive statistics and one-way ANOVA. The results showed that about 98 % of the respondents perceived that area closure would be an effective way to restore degraded land. Majority of the farmers (86 %) believed that area closure could reduce soil erosion and replenish soil fertility and thus, is beneficial in improving land productivity. Soil test results revealed that AC-SWC had significantly greater (P < 0.05) clay fractions, pH, available potassium, and available phosphorus than OG-SWC and OG. Variations of soil organic carbon (SOC) and total nitrogen (TN) were more pronounced. The SOC in AC-SWC was 83 % and 314 % greater than OG-SWC and OG, respectively. In the AC-SWC, TN was three and seven times higher than that of OG-SWC and OG, respectively. This could be due to vegetation restoration that reduces erosion, and enhances organic matter, moisture, and nutrient. The SOC, TN, pH, available potassium, and clay were significantly greater (P < 0.05) at lower slope position than upper in all forms of land management, which could be due to deposition at downslope. About 12 % and 11 % variations of clay fractions and SOC were, respectively, observed in between upper and lower slope positions at AC-SWC, but they varied by 25 % and 57 %, respectively, in OG. These imply area closure has had a beneficial effect on soil properties even on sloping land. AC-SWC is an important option to integrate in land management for rehabilitation of degraded soil., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Economic value (EV), sensitivity of EV and relative economic importance of milk yield (MY), age at first calving (AFC), calving interval (CI) and herd life (HL) traits were estimated for smallholder dairy cattle production in the central part of Ethiopia. The data on biological and economic parameters were collected using household interview and group discussions methods participating 238 farmers who had crossbred dairy cattle. Bio-economic model was used to calculate EV, sensitivity of EV and relative importance of EV. Cost of animal feed takes the highest share which accounted 81.35% of the total expenditure. The overall average profit per farmer expressed in Ethiopia currency (ETB, 1 US-$ = 39.55696 ETB) was 72,458.10 ± 5068 per year. Profitability of crossbred dairy cattle significantly varied (P < 0.05) between zones. Economic value estimated for MY, AFC, CI and HL in ETB were 13.38/kg, -16.19/day, -33.58/day and 79.55/day. The associated EV per additive standard deviation were 6083.62, -1311.59, -1271.05 and 117.73 ETB for MY, AFC, CI and HL, respectively. Analysis of sensitivity to scenario change (± 20%) showed that milk price had positive association with profit and EV, whereas feed price has inversely influenced both profit and EV. The profit obtained by farmers was altered by ± 29.08% and ± 12.31% as milk price and feed price fluctuated by ± 20%, respectively. Similarly, the EV of MY was changed by ± 20% with change in milk price and ± 7% with feed price. Scenario change in feed price (± 20%) has also caused ± 13.63% change on EV for AFC and ± 17.58% for CI. It can be noted that profit and EV of the traits were less sensitive to the change in price of milk, feed and labor. In general, the results of EV and profitability were encouraging for dairy farmers and the estimates can be used as an input for development of breeding program in the study area., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Snakebite envenoming (SBE) is a potentially life-threatening event that can lead to severe physical, mental, and economic hardships, particularly in under-resourced regions like sub-Saharan Africa. In Rwanda, there have been no epidemiological assessments of SBE to guide the Ministry of Health in its efforts to reduce the burden. This study had two main objectives: first, to estimate the incidence of snakebites across districts, and second, to describe formal versus informal healthcare seeking behaviors among snakebite victims in Eastern Province, Rwanda in 2020., Methodology: This cross-sectional study utilized a cluster sampling approach, involving Community Health Workers (CHWs) who recorded snakebite cases across seven districts. The descriptive analysis considered sampling weights, and healthcare seeking behavior was assessed based on the type of care sought as the first point of treatment., Findings: The study surveyed 390,546 individuals across 763 villages and estimated a provincial annual incidence rate of 4.3 cases per 1,000 individuals. Incidence estimates ranged from 1.1 cases per 1,000 in Nyagatare to 9.1 cases per 1,000 individuals in Bugesera and Ngoma districts. Among the 2,545 cases recorded by CHWs, three resulted in deaths. Regarding healthcare-seeking behavior, 13% of snakebite victims (143 out of 1,098) initially consulted formal care providers (CHWs, health post/center, or hospital), while 87% sought informal care (family/friends, pharmacist, or traditional healer). Approximately half of the victims (583, 53.1%) reported severe symptoms. Unsafe practices included skin cutting/burning, tourniquet application, use of black stones, and venom extraction; only 24 cases (2.2%) received anti-venom., Conclusions: This large-scale community-based assessment highlights variations in snakebite incidence between districts and confirms frequent involvement of traditional healers in management. Improving access to anti-venom and community education on the risks of ineffective practices, along with timely use of formal healthcare, are crucial. Collaboration between healthcare providers, traditional healers, community leaders, and policymakers is essential to implement targeted interventions for enhancing snakebite prevention and management strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hakizimana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Implementing an appropriate breeding program is crucial to control fluctuation in performance, enhance adaptation, and further improve the crossbred population of dairy cattle. Five alternative breeding programs (BPs) were modeled considering available breeding units in the study area, the existing crossbreeding practices, and the future prospects of dairy research and development in Ethiopia. The study targeted 143,576 crossbred cows of 54,822 smallholder households in the Arsi, West Shewa, and North Shewa zones of the Oromia Region, as well as the North Shewa zone of the Amhara Region. The alternative BPs include conventional on-station progeny testing (SPT), conventional on-farm progeny testing (FPT), conventional on-station and on-farm progeny testing (SFPT), genomic selection (GS), and genomic progeny testing (GPT). Input parameters for modeling the BPs were taken from the analysis of long-term data obtained from the Holetta Agricultural Research Center and a survey conducted in the study area. ZPLAN+ software was used to predict estimates of genetic gain (GG) and discounted profit for goal traits. The predicted genetic gains (GGs) for milk yield (MY) per year were 34.52 kg, 49.63 kg, 29.35 kg, 76.16 kg, and 77.51 kg for SPT, FPT, SFPT, GS, and GPT, respectively. The GGs of the other goal traits range from 0.69 to 1.19 days per year for age at first calving, from 1.20 to 2.35 days per year for calving interval, and from 0.06 to 0.12 days per year for herd life. Compared to conventional BPs, genomic systems (GPT and GS) enhanced the GG of MY by 53%-164%, reduced generation interval by up to 21%, and improved the accuracy of test bull selection from 0.33 to 0.43. The discounted profit of the BPs varied from 249.58 Ethiopian Birr (ETB, 1 USD = 39.55696 ETB) per year in SPT to 689.79 ETB per year in GS. Genomic selection outperforms SPT, SFPT, and FPT by 266, 227%, and 138% of discounted profit, respectively. Community-based crossbreeding accompanied by GS and gradual support with progeny testing (GPT) is recommended as the main way forward to attain better genetic progress in dairy farms in Ethiopia and similar scenarios in other tropical countries., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hunde, Tadesse, Tadesse, Abegaz and Getachew.)

SARS-CoV-2 co-infection with the influenza virus or human respiratory syncytial virus (RSV) may complicate its progress and clinical outcomes. However, data on the co-detection of SARS-CoV-2 with other respiratory viruses are limited in Ethiopia and other parts of Africa to inform evidence-based response and decision-making. We analyzed 4,989 patients' data captured from the national severe acute respiratory illness (SARI) and influenza-like illness (ILI) sentinel surveillance sites over 18 months period from January 01, 2021, to June 30, 2022. Laboratory specimens were collected from the patients and tested for viral respiratory pathogens by real-time, reverse transcription polymerase chain reaction (RT-PCR) at the national influenza center. The median age of the patients was 14 years (IQR: 1-35 years), with a slight preponderance of them being at the age of 15 to less than 50 years. SARS-CoV-2 was detected among 459 (9.2%, 95% CI: 8.4-10.0) patients, and 64 (1.3%, 95% CI: 1.0-1.6) of SARS-CoV-2 were co-detected either with Influenza virus (54.7%) or RSV (32.8%) and 12.5% were detected with both of the viruses. A substantial proportion (54.7%) of SARS-CoV-2 co-detection with other respiratory viruses was identified among patients in the age group from 15 to less than 50 years. The multivariable analysis found that the odds of SARS-CoV-2 co-detection was higher among individuals with the age category of 20 to 39 years as compared to those less than 20 years old (AOR: 1.98, 95%CI:1.15-3.42) while the odds of SARS-CoV-2 co-detection was lower among cases from other regions of the country as compared to those from Addis Ababa (AOR:0.16 95%CI:0.07-0.34). Although the SARS-CoV-2 co-detection with other respiratory viral pathogens was minimal, the findings of this study underscore that it is critical to continuously monitor the co-infections to reduce transmission and improve patient outcomes, particularly among the youth and patients with ILI., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

This study aimed to determine the concentrations of ascorbic acid and polyphenols in fruits and peels of Citrus medica and Ziziphus spina-christi grown in Ethiopia . Conditions of ultrasound-assisted extraction (UAE) and ultra-high-performance liquid chromatography coupled with a diode array detector (HPLC-DAD) were optimized, using a multivariate experimental design. The optimum conditions of UAE were 15 min extraction time at 35 ℃, with 75 % aqueous methanol as solvent, and a fruit powder-to-solvent ratio (m/v) of 1:15. Among the different drying conditions investigated, freeze-drying was found to be appropriate for analyzing ascorbic acid, polyphenols, and antioxidant potential. The overall ranges, across the fruits and peels, of ascorbic acid, total polyphenols, and antioxidant potentials (EC50) obtained were 8.7 ± 1.4-91.2 ± 2.6 mg/100 g, 253.0 ± 6.3-764.1 ± 25.8 mg GAE/100 g and 2.4 ± 0.1-26.1 ± 2.9 mg/mL, respectively. This indicates that the fruits and peels of the studied plants are advantageous as sources of ascorbic acid and polyphenols., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Main Conclusion: Seed priming with gas plasma-activated water results in an increased ageing resilience in Eragrostis tef grains compared to a conventional hydropriming protocol. Tef (Eragrostis tef) is a cereal grass and a major staple crop of Ethiopia and Eritrea. Despite its significant importance in terms of production, consumption, and cash crop value, tef has been understudied and its productivity is low. In this study, tef grains have undergone different priming treatments to enhance seed vigour and seedling performance. A conventional hydropriming and a novel additive priming technology with gas plasma-activated water (GPAW) have been used and tef grains were then subjected to germination performance assays and accelerated ageing. Tef priming increases the germination speed and vigour of the grains. Priming with GPAW retained the seed storage potential after ageing, therefore, presenting an innovative environmental-friendly seed technology with the prospect to address variable weather conditions and ultimately food insecurity. Seed technology opens new possibilities to increase productivity of tef crop farming to achieve a secure and resilient tef food system and economic growth in Ethiopia by sustainable intensification of agriculture beyond breeding., (© 2024. The Author(s).)

Enset (Ensete ventricosum (Welw.) Cheesman) is an indigenous multipurpose plant in Ethiopia. More than 20 % of people in Ethiopia rely on enset for their subsistence livelihood. Its fermentation produces a starchy food named Kocho , which is yet poorly studied. In this study, physicochemical and microbial community dynamics of Kocho fermented from different enset varieties (Maziya, Genna, and Arkiya) were collected at Dawro Zone (Southern Ethiopia). Samples were collected at various fermentation times (days 1-60) for physicochemical and microbial (culture-dependent and culture-independent) characterization. Results showed that increasing fermentation time has a significantly strong positive (R 2  = 0.768, p = 0.004) correlation between titrable acidity, and a significantly strong negative association with pH (R 2  = -0.715, p = 0.009), moisture (R 2  = -0.982, p < 0.05), ash (R 2  = -0.932, p < 0.05), fat (R 2  = -0.861, p < 0.05), fiber (R 2  = -0.981, p < 0.05) and carbohydrate (R 2  = -0.994, p < 0.001) contents. An increasing or decreasing trend of physicochemical parameters observed during enset fermentation is significantly associated with microbial community dynamics. Shifts of microbial community observed during culture-dependent analysis were also confirmed by metagenomic results. During fermentation, Firmicutes (39-68 %)  >  Proteobacteria (7-53 %)  >  Cyanobacteria (7-24 %) were dominant phyla in the three enset varieties. Gamma (traditional starter culture) is dominated by Lactobacillus plantrum and Lactobacillus manihotivorans most probably the two species that play a significant role in initiating enset fermentation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly used diabetes and obesity medications but have been associated with gastrointestinal (GI) adverse events. However, real-world evidence on comparative GI adverse reaction profiles is limited., Objectives: This study aimed to evaluate GI adverse events among GLP-1 RA users and compare semaglutide, dulaglutide, liraglutide, and exenatide safety regarding the GI adverse reaction profile., Methods: This retrospective cross-sectional analysis utilized real-world data on 10,328 adults with diabetes/obesity in the National Institutes of Health All of Us cohort. New GLP-1 RA users were identified, and GI adverse events were examined. Logistic regression determined factors associated with GI adverse events., Results: The mean age of the study population was 61.4 ± 12.6 years, 65.7% were female, 51.3% were White, and they had a high comorbidity burden. Abdominal pain (57.6%) was the most common GI adverse event, followed by constipation (30.4%), diarrhea (32.7%), nausea and vomiting (23.4%), GI bleeding (15.9%), gastroparesis (5.1%), and pancreatitis (3.4%). Dulaglutide and liraglutide had higher rates of abdominal pain, constipation, diarrhea, and nausea and vomiting than semaglutide and exenatide. Liraglutide and exenatide had the highest pancreatitis (4.0% and 3.8%, respectively). Compared to semaglutide, dulaglutide and liraglutide had higher odds of abdominal pain, and nausea and vomiting. They also had higher odds of gastroparesis than semaglutide. No significant differences existed in GI bleeding or pancreatitis risks between the GLP-1 RAs., Conclusions: In this real-world cohort, GI adverse events were common with GLP-1 RAs. Differences in GI safety profiles existed between agents, with exenatide appearing safer than other GLP-1 RAs, except for gastroparesis. These findings can inform GLP-1 RA selection considering GI risk factors. Further studies are needed to evaluate the causal relationship and GLP-1 RA safety with concomitant medication use.

Introduction: Small bowel obstruction (SBO) is one of the most common causes for hospital admission in Ethiopia. The use of water-soluble contrast agents (WSCAs) such as Gastrografin to manage adhesive SBO can predict nonoperative resolution of SBO and reduce decision time to surgery and length of hospital stay. However, nothing is known about practice patterns and Gastrografin use in low-income settings. We sought to characterize current management practices, including use of WSCAs, as well as outcomes for patients with SBO in Addis Ababa, Ethiopia., Methods: We conducted a mixed-methods study consisting of a survey of surgeons throughout Ethiopia and a retrospective record review at five public, tertiary care-level teaching hospitals in Addis Ababa., Results: Of the 76 surgeons who completed the survey, 63% had heard of the use of WSCAs for SBO and only 11% used oral agents for its management. Chart review of 149 patients admitted with SBO showed the most common etiology was adhesion (39.6% of admissions), followed by small bowel volvulus (20.8%). Most patients (83.2%) underwent surgery during their admission. The most common diagnosis in patients who did not require surgery was also adhesion (68.0%), as well as for those who had surgery (33.9%), followed by small bowel volvulus (24.2%)., Conclusions: The etiology of SBO in Ethiopia may be changing, with postoperative adhesions becoming more common than other historically more prevalent causes. Although a Gastrografin protocol as a diagnostic and potentially therapeutic aid for SBO is feasible in this population and setting, challenges can be anticipated, and future studies of protocol implementation and effectiveness are needed to further inform its utility in Ethiopia and other low-income and middle-income countries., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: Pyrazinamide (PZA) susceptibility testing is important to develop evidence-based algorithms for case management. We aimed to assess the prevalence of PZA-resistance and its impact on treatment outcomes in previously treated tuberculosis (TB) cases in southwestern Oromia, Ethiopia., Methods: A Phenotypic Drug Susceptibility Testing (DST) of PZA with BACTEC MGIT 960 was conducted at the Mycobacteriology Research Center of Jimma University (MRC-JU) from June to November 2021 on sixty-six Mycobacterium tuberculosis complex (MTBC) isolates from previously treated TB cases. SPSS software package version 21 was used. The differences in the proportion of PZA resistance between the groups were compared using the chi squared test. Logistic regression was used to identify the association between PZA resistance and treatment outcomes., Results: Among 66 MTBC isolates (49 rifampicin-resistant and 17 rifampicin-sensitive) included in this study, 31.8 % were resistant to PZA. The proportion of PZA resistance was almost three times higher in previously treated TB cases with rifampicin resistance than in rifampicin-sensitive patients (38.8 % vs. 11.8 %, p = 0.039). An unfavorable treatment outcome was documented for 23 % (15/65) of the participants. Patients with PZA resistance were almost four times more likely to have an unfavorable treatment outcome than patients with PZA sensitive (aOR 4.2, 95 % CI: 1.13-15.3)., Conclusions: The prevalence of PZA resistance was high compared to the pooled PZA resistance estimated worldwide. The majority of TB cases with PZA resistance had an unfavorable treatment outcome. PZA susceptibility testing should be included in the multidrug-resistant TB diagnostic algorithm to improve management of these patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Background: Accurate drug susceptibility testing (DST) of Mycobacterium tuberculosis (MTB) is essential for proper patient management. We investigated discordance between genotypic (Xpert MTB/RIF and MTBDR plus ) and phenotypic (MGIT 960) methods for the detection of rifampicin (RIF) and isoniazid (INH) resistant MTB and its correlation with patient treatment outcomes in Jimma, Southwest Oromia, Ethiopia., Methods: A retrospective study was conducted on 57 stored MTB isolates with known Xpert RIF resistance status (45 RIF resistant and 12 RIF susceptible) at Jimma University Mycobacteriology Research Center from November 2, 2021, to December 28, 2022. We did MTBDR plus and phenotypic DST (using the Mycobacterial Growth Indicator Tube (MGIT) system). The Xpert and MTBDR plus results were compared using phenotypic DST as a reference standard method. The treatment outcome was determined as per national guideline. The discordance between the genotypic and phenotypic DST was calculated using GraphPad software., Results: Among the 57 MTB isolates, six (10.5 %) had discordant results between the two DST methods. Xpert yielded five discordant results for RIF when compared with phenotypic DST (kappa coefficient (κ) = 0.76, 95 % confidence interval 0.56-0.96). The MTBDR plus compared with phenotypic DST gave three discordant results for RIF (κ = 0.86, 95 % confidence interval 0.71-1.00) and three for INH (κ = 0.86, 95 % confidence interval 0.70-1.00). Compared with Xpert, MTBDR plus yielded lower discordance with phenotypic DST for RIF. Out of six patients with discordant results, three had unfavorable outcomes while the other three were cured. Of the three patients with unfavorable outcomes, only one patient has received an inappropriate treatment regimen. There was no correlation between unfavorable outcomes and incorrect treatment regimens due to discordant results (Χ 2 = 0.404; P = 0.525)., Conclusions: Discordance between genotypic and phenotypic DST for RIF or INH occurred in 10.5 % of isolates. Only one patient with discordant results has received an inappropriate treatment regimen, resulting in an unfavorable outcome. The impact of parallel use of rapid molecular assay with phenotypic DST on patient treatment outcomes requires further study., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

The Mycobacterium tuberculosis complex (MTBC) includes several human- and animal-adapted pathogens. It is thought to have originated in East Africa from a recombinogenic Mycobacterium canettii-like ancestral pool. Here, we describe the discovery of a clinical tuberculosis strain isolated in Ethiopia that shares archetypal phenotypic and genomic features of M. canettii strains, but represents a phylogenetic branch much closer to the MTBC clade than to the M. canettii strains. Analysis of genomic traces of horizontal gene transfer in this isolate and previously identified M. canettii strains indicates a persistent albeit decreased recombinogenic lifestyle near the emergence of the MTBC. Our findings support that the MTBC emergence from its putative free-living M. canettii-like progenitor is evolutionarily very recent, and suggest the existence of a continuum of further extant derivatives from ancestral stages, close to the root of the MTBC, along the Great Rift Valley., (© 2023. The Author(s).)

Introduction: Receiving adequate antenatal care (ANC) had an integral role in improving maternal and child health outcomes. However, several factors influence the utilization of ANC from the individual level up to the community level factors. Thus, this study aims to investigate factors that determine ANC service utilization among mothers of deceased perinate using the proper count regression model., Method: Secondary data analysis was performed on perinatal death surveillance data. A total of 3,814 mothers of deceased perinates were included in this study. Hurdle Poisson regression with a random intercept at both count-and zero-part (MHPR.ERE) model was selected as a best-fitted model. The result of the model was presented in two ways, the first part of the count segment of the model was presented using the incidence rate ratio (IRR), while the zero parts of the model utilized the adjusted odds ratio (AOR)., Result: This study revealed that 33.0% of mothers of deceased perinates had four ANC visits. Being in advanced maternal age [IRR = 1.03; 95CI: (1.01-1.09)], attending primary level education [IRR = 1.08; 95 CI: (1.02-1.15)], having an advanced education (secondary and above) [IRR = 1.14; 95 CI: (1.07-1.21)] and being resident of a city administration [IRR = 1.17; 95 CI: (1.05-1.31)] were associated with a significantly higher frequency of ANC visits. On the other hand, women with secondary and above education [AOR = 0.37; 95CI: (0.26-0.53)] and women who live in urban areas [AOR = 0.42; 95 CI: (0.33-0.54)] were less likely to have unbooked ANC visit, while women who resided in pastoralist regions [AOR = 2.63; 95 CI: (1.02-6.81)] were more likely to have no ANC visit., Conclusion: The uptake of ANC service among mothers having a deceased perinate was determined by both individual (maternal age and educational status) and community (residence and type of region) level factors. Thus, a concerted effort is needed to improve community awareness through various means of communication by targeting younger women. Furthermore, efforts should be intensified to narrow down inequalities observed in ANC service provision due to the residence of the mothers by availing necessary personnel and improving the accessibility of service in rural areas., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tesfay, Kebede, Asamene, Tadesse, Begna and Woldeyohannes.)

Background: Inappropriate complementary feeding is one of the leading causes of malnutrition among children 6-23 months old and delays children's growth milestone. The determinants of inappropriate complementary feeding practice have diverse natures, so that many of the previous studies fail to generate adequate evidence on it. This study aim to address the determinants of in appropriate complementary feedings at community level., Methods: A community-based unmatched case-control study design was carried out among children 6-23 months of age in Dessie City from April 13, 2021 to May 13, 2021. Nine kebeles were selected by simple random sampling method. One month prior to the data collection time survey was conducted and 482 samples were taken from the preliminary survey data; 241 cases and 241 controls by computer generated random numbers. Interviewer administered questionnaire was used to investigate potential determinants of inappropriate complementary feeding practice. Binary logistics regression was used to identify independent determinants., Results: Part working situation of mother [AOR = 0.21 CI: 0.08, 0.52] was negatively associated with inappropriate complementary feeding. Having no post-natal care visit [AOR = 4.062 CI:2.35,7.02], poor wealth status [AOR = 2.7 CI:1.09,6.68], food in-security [AOR = 4.49 CI:1.94,10.37], home delivery [AOR = 4.33 CI:1.43,13.15], having poor knowledge on infant and young child feeding [AOR = 5.94 CI:2.8,12.6], having no health education on complementary feeding [AOR = 2.54 CI:1.28,5.06] and father's job [AOR = 2.2 CI:1.17,4.1] were found to be positively associated with inappropriate complementary feeding., Conclusion: Mothers' work situation, fathers' job, wealth index, food security, mothers' knowledge on infant feeding, post-natal care, health education on infant feeding and place of delivery were independent determinants for inappropriate complementary feeding. Thus, interventions shall effectively address those factors to alleviate the problem., (© 2023. The Author(s).)

Background: Cesarean section (CS) is a surgical procedure where the baby is delivered through incisions made in the abdomen and uterus. Bupivacaine is a widely recognized local anesthetic available in different baricity and it is frequently used for spinal anesthesia. The baricity of bupivacaine impacts hemodynamic profiles and block characteristics., Objective: To compare the effects of hyperbaric and isobaric bupivacaine on hemodynamic profiles and block characteristics among parturients undergoing elective cesarean section under spinal anesthesia at Dilla University Referral Hospital., Methods: 64 pregnant mothers scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups: Group A received a dose of 12.5 mg of isobaric bupivacaine (n = 32), Group B received a dose of 12.5 mg of hyperbaric bupivacaine (n = 32). Prior to conducting the study, the necessary ethical approvals were obtained. For comparing numerical variables between the two groups, the independent Sample t -test or Mann-Whitney U -test was employed as needed. Repeated measurements were analyzed using mixed ANOVA. Categorical variables were assessed using either the chi-square test or Fisher's exact test. Statistical significance was set at P < 0.05, with a power of 90%., Results: The mean Systolic Blood Pressure (SBP), Diastolic Blood pressure (DBP), and Mean Arterial Blood Pressure (MAP) showed significant decrement in the group receiving isobaric spinal anesthesia compared to those receiving hyperbaric bupivacaine. The decrement was observed from the 6th to 30th minute (p<0.05). Furthermore, the hyperbaric group had a faster onset time for achieving the maximum sensory block, with a median time of 3 (1) min compared to 4 (2) mins in the isobaric group (p<0.001)., Conclusion and Recommendation: We conclude that hyperbaric bupivacaine provides stable intraoperative hemodynamic parameters and an earlier onset of block than isobaric bupivacaine. Therefore, we recommend clinicians to use hyperbaric bupivacaine for cesarean delivery., Competing Interests: The authors declare that they have no competing interests in this work., (© 2023 Besha et al.)

Background: Although antimicrobial resistance (AMR) bacteria present a significant and ongoing public health challenge, its magnitude remains poorly understood, especially in many parts of the developing countries. Hence, this review was conducted to describe the current pooled prevalence of drug resistance, multidrug- resistance (MDR), and Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, Acinetobacter, and Pseudomonas species in humans, the environment, and animals or food of animal origin in Ethiopia., Methods: PubMed, Google Scholar, and other sources were searched for relevant articles as per the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A critical appraisal for screening, eligibility, and inclusion in the meta-analysis was made based on the Joanna Briggs Institute's (JBI) essential appraisal tools. The meta-analysis was done on Statistical Software Package (STATA) version 17.0., Results: A total of 33 research articles were included in this systematic review and meta-analysis. Escherichia coli, Klebsiella species, Acinetobacter, and Pseudomonas species were the most frequently reported bacteria from two or more sources. More than 50% of Klebsiella species and 25% to 89% of Escherichia coli from two or more sources were resistant to all analysed antibiotics, except carbapenems. Fifty-five percent (55%) to 84% of Acinetobacter species and 33% to 79% of Pseudomonas species from human and environmental sources were resistant to all analyzed antibiotics. Carbapenem resistance was common in Acinetobacter and Pseudomonas species (38% to 64%) but uncommon in Enterobacteriaceae (19% to 44%). Acinetobacter species (92%), Klebsiella species (86%), and Pseudomonas species (79%) from human sources, and Proteus species (92%), and Acinetobacter species (83%), from environmental sources, were the common multidrug-resistant isolates. About 45% to 67% of E. coli, Klebsiella, Acinetobacter, and Pseudomonas species from human and environmental sources were ESBL producers., Conclusion: Our review report concluded that there was a significant pooled prevalence of drug resistance, MDR, and ESBL-producing Enterobacteriaceae, Acinetobacter, and Pseudomonas species from two or more sources. Hence, our finding underlines the need for the implementation of integrated intervention approaches to address the gaps in reducing the emergence and spread of antibiotic- resistant bacteria., (© 2023. BioMed Central Ltd.)

Background: Major Adverse Cardiovascular Events (MACE) are common complications of type 2 diabetes mellitus (T2DM) that include myocardial infarction (MI), stroke, and heart failure (HF). The objective of the current study was to predict MACE among T2DM patients., Methods: Type 2 diabetes mellitus patients above 18 years old were recruited for the study from the All of Us Research Program. Eligible participants were those who took sodium-glucose cotransporter 2 inhibitors. Different Machine learning algorithms: including RandomForest (RF), XGBoost, logistic regression (LR), and weighted ensemble model (WEM) were employed. Clinical attributes, electrolytes and biomarkers were explored in predicting MACE. The feature importance was determined using mean decrease accuracy., Results: Overall, 9, 059 subjects were included in the analyses, of which 5197 (57.4%) were females. The XGBoost Model demonstrated a prediction accuracy of 0.80 [0.78-0.82], which is higher as compared to the RF 0.78[0.76-0.80], the LR model 0.65 [0.62-0.67], and the WEM 0.75 [0.73-0.76], respectively. The classification accuracy of the models for stroke was more than 95%, which was higher than prediction accuracy for MI (∼85%), and HF (∼80%). Phosphate, blood urea nitrogen and troponin levels were the major predictors of MACE., Conclusion: The ML models had shown acceptable performance in predicting MACE in T2DM patients, except the LR model. Phosphate, blood urea nitrogen, and other electrolytes were important predictors of MACE, which is consistent between the individual components of MACE, such as stroke, MI, and HF. These parameters can be calibrated as prognostic parameters of MACE events in T2DM patients., Competing Interests: Declaration of competing interest The authors declare no competing interest. The study did not receive financial support., (Published by Elsevier Ltd.)

The home of Coffea arabica is in Ethiopia, where it has high genetic diversity and suitable growing conditions; unfortunately, the national average yields of coffee remain low due to no technical advancements and diverse, complex biotic and abiotic constraints. Hence, this study was conducted in eight major coffee-growing zones of Ethiopia to assess farmers' knowledge and perceptions of coffee yield reduction due to weeds and the farmers' weed control practices. A purposive and random sampling technique was used to generate primary data from coffee growers ( N  = 320) using a semi-structured questionnaire. Quantitative data were analyzed using a three-stage nested design, and the dependent and independent variables data were subjected to canonical correlation analysis. This study revealed variation in coffee yield (t ha -1 ) among the assessed areas based on farmers' knowledge of estimating coffee yield. The average yield level ha -1 was very low (0.37 t ha -1 ) and different among the surveyed areas. The average coffee yield gap as compared to the current national level (0.64 t ha -1 ) was observed to be 42%, and this low yield was highly correlated with weed infestation (r = 0.879) and type of weeds r = -0.528). This investigation indicated a single factor or association of different factors contributing to the low yield level of coffee in the study areas. Thus, it is concluded that predictor variables accounting for the low yield levels need to be considered when planning future strategies to attain the yield potential of C. arabica in Ethiopia., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Ecological sanitation combined with thermophilic composting is a viable option to transform human excreta into a stabilized, pathogen-free, and nutrient-rich fertilizer. In combination with suitable bulking materials such as sawdust and straw, and additives such as biochar, this could also be a suitable waste management strategy for reducing greenhouse gas (GHG) emissions. In this study, we conducted a 143-days thermophilic composting of human excreta or cattle manure together with teff straw, organic waste, and biochar to investigate the effect that biochar has on GHG (CO 2 , N 2 O, and CH 4 ) and NH 3 emissions. The composting was performed in wooden boxes (1.5 × 1.5 × 1.4 m 3 ), GHG were measured by using a portable FTIR gas analyzer and NH 3 was sampled as ammonium in an H 2 SO 4 trap. We found that the addition of biochar significantly reduced CH 4 emissions by 91% in the cattle manure compost, and N 2 O emissions by 56%-57% in both humanure and cattle manure composts. Overall, non-CO 2 GHG emissions were reduced by 51%-71%. In contrast, we did not observe a significant biochar effect on CO 2 and NH 3 emissions. Previous data already showed that it is possible to sanitize human fecal material when using this composting method. Our results suggest that thermophilic composting with biochar addition is a safe and cost-effective waste management practice for producing a nutrient-rich fertilizer from human excreta, while reducing GHG emissions at the same time., (© 2023 The Authors. Journal of Environmental Quality published by Wiley Periodicals LLC on behalf of American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.)

Objective: This study aimed to map disparities in prevalence and associated factors across countries in Sub-Saharan Africa., Methods: We used National Demographic and Health Survey (DHS) data from 26 countries in the region with 114,340 participants. Women and girls in the reproductive age group of 15 to 49 years were included in the study. To map disparities across countries and their provinces, we employed the kriging interpolation technique. We used STATA for data management., Result: The prevalence of physical, emotional and sexual IPV in Sub-Saharan Africa was 30.58, 30.22, and 12.6% respectively, and at least one form of IPV was 42.62%. Disparities were observed across the countries and provinces in each country. Younger age, secondary-level education and above, moderate participation in decision-making, not working out of home, not afraid of the spouse, rich (wealth index), not having a child, high maternal literacy, and rural residence relatively decreased the odds of IPV. The husbands' lower education, alcohol consumption, and high controlling behavior increased the probability of IPV., Conclusion: The prevalence of Intimate Partner Violence in Sub-Saharan Africa is the highest in the world, a signal that the global agenda to end all forms of violence against women will be difficult to achieve. There is a large gap across countries and provinces in each country. Area-specific intervention packages that focus on modifiable factors should be strengthened., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mossie, Fenta, Tadesse and Tadele.)

Background: Preserving the mother's safety, sustaining the pregnancy state, and achieving the optimal fetal outcome are the major priorities when managing obstetric patients for non-obstetric surgery. Only necessary and urgent surgeries are carried out during pregnancy due to the effects of anesthesia and surgery on the fetus. Compound bowel obstruction (small and large bowel obstruction) is rare, especially during the third trimester of pregnancy. Besides this, the procedure (laparotomy) was done with awake opioid-based thoracic epidural anesthesia as the sole anesthesia. This case report of awake laparotomy for major abdominal surgery is the first of its kind with an excellent feto-maternal outcome., Case Presentation: A 30-year-old African pregnant lady presented to the emergency department with a chief complaint of abdominal pain and vomiting for an 8-hour duration; associated with this, she had a history of blurred vision, lightheadedness, loss of appetite, low-grade fever, and constipation. Later, she was diagnosed with large bowel obstruction and underwent an emergency laparotomy, managed with a thoracic epidural sole anesthesia., Conclusion: A multidisciplinary team approach is greatly recommended to safeguard a sufficient standard of care for both the mother and fetus. The provision of regional anesthesia for patients with high risks in perioperative periods is crucial for a better postoperative outcome. We have confidence that thoracic epidural anesthesia can be used as another anesthetic option for major abdominal surgery in a resource-restricted setting for patients who are expected to have a significant risk of perioperative adverse events under general anesthesia., (© 2023. The Author(s).)

There is a paucity of predictive models for uncontrolled diabetes mellitus. The present study applied different machine learning algorithms on multiple patient characteristics to predict uncontrolled diabetes. Patients with diabetes above the age of 18 from the All of Us Research Program were included. Random forest, extreme gradient boost, logistic regression, and weighted ensemble model algorithms were employed. Patients who had a record of uncontrolled diabetes based on the international classification of diseases code were identified as cases. A set of features including basic demographic, biomarkers and hematological indices were included in the model. The random forest model demonstrated high performance in predicting uncontrolled diabetes, yielding an accuracy of 0.80 (95% CI: 0.79-0.81) as compared to the extreme gradient boost 0.74 (95% CI: 0.73-0.75), the logistic regression 0.64 (95% CI: 0.63-0.65) and the weighted ensemble model 0.77 (95% CI: 0.76-0.79). The maximum area under the receiver characteristics curve value was 0.77 (random forest model), while the minimum value was 0.7 (logistic regression model). Potassium levels, body weight, aspartate aminotransferase, height, and heart rate were important predictors of uncontrolled diabetes. The random forest model demonstrated a high performance in predicting uncontrolled diabetes. Serum electrolytes and physical measurements were important features in predicting uncontrolled diabetes. Machine learning techniques may be used to predict uncontrolled diabetes by incorporating these clinical characteristics.

Globally, emergency laparotomy is a frequently performed type of surgery with high morbidity and mortality rates, even in the best healthcare systems. There is limited knowledge regarding the outcome of emergency laparotomy performed in Ethiopia., Objective: To assess perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals., Methods: A multicenter prospective cohort study was conducted, and data were collected at selected hospitals after obtaining ethical approval from the Institutional Review Board. Data were analyzed using SPSS version 26., Results: The rate of postoperative complications after emergency laparotomy surgery was 39.3%, with an in-hospital mortality rate of 8.4% and a length of hospital stay of 9±6.5 days. The predictors of postoperative mortality were the age of the patient greater than 65 [adjusted odds ratio (AOR)=8.46, 95% CI=1.3-57.1], presence of intraoperative complications (AOR=7.26, 95% CI=1.3-41.3), and postoperative ICU admission (AOR=8.5, 95% CI=1.5-49.6)., Conclusion: Our study revealed a significant level of postoperative complications and in-hospital mortality. The identified predictors should be sorted and applied to the preoperative optimization, risk assessment, and standardization of effective postoperative care following emergency laparotomy., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Streptococcus pyogenes ( S. pyogenes ) or group A streptococcus is a common cause of bacterial pharyngitis in children. Since it is difficult to distinguish between viral and bacterial pharyngitis using solely signs and symptoms, culture-based diagnosis and treatment are critical for avoiding serious complications. Therefore, this study aimed to determine the prevalence, antimicrobial susceptibility patterns, and associated factors of S. pyogenes among pediatric patients with acute pharyngitis., Methods: A hospital-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital from April to June 2021. Standard microbiological procedures were used to collect and process throat swabs and to isolate and identify S. pyogenes . The disc diffusion method was used for antimicrobial susceptibility testing (AST)., Results: A total of 215 children with acute pharyngitis were included in this study. Of these, 23 (10.7%) were culture positive for S. pyogenes . The presence of an inflamed tonsil, tonsillar exudate, scalariform rash, and dysphagia were associated with streptococcal pharyngitis. Children aged 5 to 15 were more susceptible to streptococcal throat infection than younger children. Penicillin, vancomycin, chloramphenicol, clindamycin, and ceftriaxone were effective against 100%, 95.7%, 95.7%, 91%, and 87% of isolates, respectively. In contrast, 56.5%, 39.1%, and 30.4% of isolates showed at least reduced susceptibility to tetracycline, erythromycin, and azithromycin, respectively., Conclusion: Streptococcus pyogenes is responsible for 10.7% of acute pharyngitis cases among pediatric patients in the study area. Although all isolates remain sensitive to penicillin, many showed reduced susceptibility to tetracycline and macrolides. Therefore, prior to antibiotic prescription, screening children with acute pharyngitis for S. pyogenes and testing the antibiotic susceptibility of isolates is recommended., Competing Interests: The authors declare that they have no competing interests in this work., (© 2023 Tadesse et al.)

Background: Entrustable Professional Activities (EPAs) are units of professional practice that are defined as tasks or responsibilities that are entrusted to an unsupervised execution by a trainee. In 2021, a framework of 29 EPAs was developed for surgical residency training programs in Ethiopia, with the goal of residents being able to perform independently by the time they graduate. However, studies show that surgical residents lack confidence and are unable to execute EPAs autonomously upon graduation, and concerns have been raised about graduate competencies in EPA execution. The goal of this research is to assess how surgical team members judge/perceive residents' performance in executing these EPAs autonomously at the time of graduation and how residents rate their own capability and autonomy in executing EPAs in order to systematically introduce and implement EPAs in Ethiopian medical education., Methods: A survey was conducted in the Departments of Surgery at four residency training institutions in Ethiopia. All eligible surgical team members and final-year general surgery residents were invited to participate. Surgical team members were asked to rate the observed performance of a group of graduating surgical residents in each of the 29 EPAs, and residents were asked to rate their own capability in executing EPAs. The analysis focused on variations in performance ratings between surgical team members and residents, as well as across surgical team members., Results: A total of 125 surgical team members and 49 residents participated in this study. Residents rate their competence in performing these EPAs higher than surgical team members, mean 4.2 (SD = 0.63) vs. 3.7 (SD = 0.9). A statistically significant difference in perceptions of capability, autonomy, and expectations in executing EPAs was observed between the two groups of study (p = 0.03, CI: 0.51-0.95), as well as within surgical team members (p < 0.001)., Conclusions: Differences in perceptions of capability, autonomy, and expectations between residents and surgical team members, as well as within faculty members, were seen in executing EPAs. There were concerns about graduate surgical residents' competence to execute EPAs autonomously at the time of graduation. Surgical team members perceived that a set of graduating surgical residents are not yet safe to perform these EPAs independently (without supervision) and still requires distant supervision., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Published by Elsevier Ltd.)

Background: The comorbidity of depression with chronic skin disease negatively affects the quality of life and disease prognosis, creating an immense burden on patients, families, and the wider community. However, there are limited studies conducted on the prevalence of depression and associated factors among people with chronic skin disease in Ethiopia., Objective: This study aimed to assess the prevalence and associated factors of depression among people with chronic skin disease at Boru Meda Hospital, Northeast Ethiopia., Methods: An institutional-based cross-sectional study was carried out from March 10- April 18, 2021, among a total of 381 people with chronic skin disease. The Patient Health Questioner-9 was used to assess depression. A logistic regression analysis model with an adjusted odds ratio was used to assess the strength of associations between the outcome and predictor variables. P-value < 0.05 was considered statistically significant., Result: The magnitude of depression among people with chronic skin disease was 23.6% (95%Cl: 19.8%, 28.6%). We identified significantly increased odds of depression among participants with rural residence (AOR = 3.45, 95% CI: 1.64, 7.28), duration of illness above 5 years (AOR = 3.59, 95% CI: 1.31, 9.85), comorbid medical illness AOR = 2.51, 95% CI: 1.06, 5.98), family history of mental illness (AOR = 3.39, 95% CI: 1.11, 10.41), non-adherence to chronic skin disease medications (AOR = 3.53, 95% CI: 1.20, 10.41), low self-image (AOR = 4.69, 95% CI: 2.25, 9.77), and perceived stigma (AOR = 4.61, 95% CI: 2.14, 9.92)., Conclusion: Depression was common among patients with chronic skin diseases. This study has indicated a need for proper screening of depression in the current medical treatment of patients with chronic skin disease in Boru Meda Hospital, Northeast Ethiopia., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Nurye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Soil erosion and its consequences is one of the major serious problems in Ethiopia. Even though adoption of soil and water conservation (SWC) measures has been underway for the past three decades, the implementation and use of introduced technologies were below the expectation and the problem is still has continued in the country. The study was aimed at assessing the implemented physical designs of soil and water conservation structures in respect to the standards and identifying the major adoption determinant factors in Wenago district, southern Ethiopia. The data for this studywas collected from a survey of 262 total household farmers selected through simple random sampling techniques in the year 2020/21 and the datawas analyzed using descriptive statistics, chi-square and logistic regression model via SPSS and Stata soft wares. Focus group discussion, key informant interview and personal observation were also undertaken to gather data having qualitative nature. (i) About 55.6% of the implemented physical design failed to meet the standards (ii) Adoption of SWC measures were determined by 47.4% of the tested variables (iii) 55.5% of the variables were significantly associated at 5% probability level between adopters and non-adopters in terms of adoption of SWC measures in the study area. Overall, we conclude that construction of conservation structures should be focused on minimizing the observed mismatch of the implemented physical designs against the standards. This study is expected to contribute in achieving sustainable land management schemes, agricultural productivity and smallholder farmers livelihood improvement in international, national, regional and local level and it is strongly recommended that policy makers and technical institutions should address SWC related issues to ensure rural farmers food security., Competing Interests: ., (© 2023 The Authors.)

Landscape management practices (LMP) support addressing the vulnerability of small-scale producers (SSPs) through providing a means of sustaining and strengthening community livelihoods and building their resilience and the environment. However, addressing the vulnerability of SSPs through the implementation of LMP requires meaningful community engagement and assessing the benefits and costs from the perspective of local communities. This study was conducted in two watersheds, Maybar-Felana and Gelana, in the Awash River basin, Ethiopia. The study assessed the links between natural resource degradation and the vulnerability of SSPs, local communities' opinion on the benefits and costs of LMP and the implications of implementing LMP for addressing vulnerability. It gathered and analyzed data through key informant interviews (KII), focus group discussions (FGDs) and GIS and remote sensing techniques. Diverse LMP such as afforestation/reforestation, exclosures, terrace and bunds and crop- and soil-based soil amendments were adopted in the studied watersheds. These practices contributed to the improvement of natural resources such as forests and the services they provide. Over the last 21 years (2000-2021), forest cover increased by 11.5 and 42.5% in Maybar-Felana and Gelana watersheds, respectively, while shrublands increased by 41.1% in Maybar-Felana. In line with this, the SSPs identified multiple benefits of LMP including the restoration of degraded vegetation, reducing runoff and soil loss, improving access to water for multiple uses and increasing agricultural productivity. The adopted LMP contributed to reducing livelihood vulnerability through reducing incidents of weather extremes such as flood and drought, improving food and water security, enhancing resource availability, and building livelihood assets. The SSPs also identified multiple economic and social costs of LMP, suggesting that addressing the economic and social costs through balancing short-term economic losses with long-term environmental benefits of interventions is crucial to sustaining the LMP and the benefits they provide., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Dietary diversity score has long been recognized as a key component of diets quality balances for healthy life status. However, diets with more variety of food items might increase calorie intake and body weight, which, in turn leads to central obesity (waist circumference).Therefore, this study aims to determine the prevalence of metabolic syndrome among dietary diversity score groups, and its associated factors among adults in the urban community of Jimma, Southwest Ethiopia., Methods: A total of 915 adults aged ≥ 18 years were randomly recruited in this cross-sectional study.The study was undertaken from June 17, 2019, up to July 27, 2019. To this end, the collected data were entered to Epi Data 3.1 and analysed using and SPSS 25 version. What's more, a multivariable logistic regression was used to assess associated factors of the unrecognized metabolic syndrome; adjusted odds ratio (AOR) with its corresponding 95% CI, at P-value ≤ 0.05., Results: The occurrence of metabolic syndrome was 14.4%, and it is more prevalent in females, 11.15% than males, and 3.25%. The most prevalent components of the metabolic syndrome were low level of high-density lipoprotein, elevated level of triacylglycerol, and waist circumferences. Even though metabolic syndrome is not significantly associated with any of the dietary diversity score groups, its prevalence distribution varies among the groups (6.6% in middle, 5.8% in high and 1.9% in low dietary diversity groups). With potential confounders adjusted, by 75% female was significantly associated with the occurrence of metabolic syndrome than male (102 vs. 29, AOR = 0.25 at 95%CI: 0.15-0.40, P = 0.001). Whereas, age ≥ 35 years old (104 vs. 27, AOR = 2.91 at 95%CI:1.78-4.86,P = 0.001), large family size > 5 (65 vs. 10,AOR = 2.43 95% CI: 1.10-5.36, P = 0.03), overweight and obesity (121 vs. 10, AOR = 6.97, 95% CI: 4.50 -10.83, P = 0.005), elevated total cholesterol (103 vs. 28,AOR = 2.46, 95% CI: 1.47-4.11, P = 0.001), and consuming ( spices, condemns and beverages) ≥ 4 days per week (79 vs. 52, AOR = 0.52, 95% CI:0.33 -0.82, P = 0.005) were positively associated with the prevalence of metabolic syndrome as compared to their counterparts., Conclusion: Unrecognized metabolic syndrome was relatively high in the study community. The prevalence of metabolic syndrome varied among dietary diversity groups. But any of the dietary diversity scoring categories was not significantly associated with the occurrence of metabolic syndrome. Thus, awareness needs to be made to practice healthy diet and regular physical activity to maintaining normal body weight. Moreover, early screening of metabolic syndrome should be promoted., (© 2022. The Author(s).)

COVID-19, the novel coronavirus, has posed a major threat to low- and middle-income countries (LMICs) due to inadequate health infrastructure and human resources. Ethiopia, a low-income country with the second largest population in Africa, has coordinated a strategic response, leveraging existing infrastructure and health systems and mobilizing public health professionals and specialist expert physicians for a multifaceted, unified government approach and adaptive response. Resource limitations, particularly in critical care, have still posed challenges, but the public health and clinical interventions thus far have prevented the catastrophic toll that many predicted. As the pandemic continues, Ethiopia expects to use a triple care model integrated at all levels, consisting of COVID-19 care, isolation care for suspected cases, and essential health services, and urges intensified non-pharmaceutical interventions alongside equitable global vaccine distribution as the ultimate answers to pandemic control. This paper draws on existing data, national planning and guidelines, and expertise from health leadership to describe this response in hopes of providing an example of how future large-scale health challenges might be faced in LMICs, using Ethiopia's successes and challenges in facing the pandemic., Competing Interests: Conflicts of interest: none declared., (© 2022 The Union.)

Background: Stroke is one of the most common causes of disability among adults. Post-stroke depression (PSD) is a frequent neuropsychiatric complication in stroke patients. Despite the increasing prevalence of stroke, there is a paucity of data on PSD and its determinants among stroke survivors in developing countries like Ethiopia. We aim to assess the factors associated with PSD in survivors of stroke., Method: A hospital-based unmatched case-control study was conducted during the period of February to July 2020 at University of Gondar Hospital among stroke survivors. Study subjects were recruited consecutively. Socio-demographic and clinical data were obtained from patients' interviews and medical record reviews. A diagnosis of PSD was made using the Patient Health Questionnaire (PHQ-9). EpiData version 3.1 was used to enter data, and SPSS version 26 was used to analyze it. Bivariate and multivariate logistic regressions were fitted to identify associated variables. The adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value 0.05 were used to determine the significance of the association., Result: A total of 240 stroke survivors were included in the study (80 cases and 160 controls). The mean age was 60.8 years (SD ± 14.3) with an equal sex distribution. Variables statistically associated with PSD were male gender (AOR = 3.5, 95% CI: 1.64-7.46 C, P-value = 0.001), subcortical location of the largest lesion (AOR = 2.42, 95% CI: 1.06-5.56, p-value = 0.036), severity of the stroke (AOR = 52.34, 95% CI:10.64-256.87, p-value = 0.000), physical disability (AOR = 5.85. 95% CI:1.94-17.65, p-value = 0.002), previous history of stroke or transient ischemic attack (AOR = 5.90, 95% CI:2.04-17.10, p-value = 0.001) and ischemic heart disease (AOR = 9.97, 95% CI:3.4-29.22, p-value = 0.000)., Conclusion: Important factors in the occurrence of PSD in this study include prior history of stroke, physical disability, severity of the stroke, subcortical location of the lesion, male gender, and ischemic heart disease. Stroke patients with such factors need routine screening for PSD, particularly in LMICs where there is uncoordinated post-stroke care, a shortage of neurologists and mental health practitioners., (© 2022. The Author(s).)

Background: Undernutrition is a frequently noticed medical problem in patients with heart failure. It is caused by poor nutrient intake, malabsorption, systemic inflammation, neurohumoral activation, oxidative stress, and hypermetabolic state. Undernutrition results in a decrease in the quality of life and the survival rate in patients with heart failure. There is a paucity of documentation on undernutrition among patients with heart failure in sub-Saharan African countries. The study aimed to determine the magnitude and associated factors of undernutrition among older adult patients with heart failure in the hospital setting in Northwest Ethiopia., Methods: An institutional-based cross-sectional study was conducted at the University of Gondar Hospital, Northwest Ethiopia, between 1 June 2021 and 31 October 2021. A consecutive sampling method was used to recruit 262 study subjects. A Mini-nutritional assessment-full form (MNA-FL) Questionnaire was used to extract nutritional information among patients with heart failure. Patients with heart failure, who scored MNA-FL score <17, were declared to have undernutrition. The data were entered into EPI Info version 4.6.0.0 and then exported to SPSS version 26 for analysis. Explanatory variables associated with undernutrition in patients with heart failure were analyzed by applying a logistic regression model. A P -value of <0.05 was used to declare a significant association., Results: A total of 262 patients with heart failure were included in the study. The mean age (± SD) of the study subjects was 64.6 (± 9.2) years. Hypertensive heart disease (111/262, 42%) was the most common cause of heart failure. Hypertension was the frequently observed comorbid disease. Based on the MNA-FL score for nutritional status, 75 out of 262 (28.6%, 95% CI: 22.9-34.4%) were undernourished (MNA-FL < 17), while 124 out of 262 (47.3%, CI: 41.5-53.1%) were at risk of undernutrition (MNA-FL = 17-23.5). The remaining 63 out of 262 (24.1%, 95% CI: 18.2-29.8%) study subjects were well nourished (MNA-FL > 24). On a multivariate analysis, patients with severe heart failure (New York Heart Association (NYHA) functional class III/IV) (AOR = 4.287, CI: 2.012-9.134, P -value < 0.001), with a duration of illness of 3-5 years (AOR = 3.225, CI: 1.138-9.137, P -value = 0.028), with a duration of illness of >5 years (AOR = 4.349, CI: 1.592-11.879, P -value = 0.001), presence of comorbidities (AOR = 2.29, CI: 1.06-4.96, P -value = 0.036), who underwent treatment with loop diuretics (AOR = 2.983, CI: 1.407-6.326, P -value = 0.040), and who reside in a rural area (AOR = 5.119, CI: 2.481-10.560, P -value < 0.001) were at risk of developing undernutrition., Conclusion: Undernutrition was a significant clinical problem in older patients with heart failure. Nutritional interventions should be prioritized for patients with chronic and severe heart failure., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ahmed, Tadesse, Alemu, Abebe and Tadesse.)

Background: Routine monitoring of anti-malarial drugs is recommended for early detection of drug resistance and to inform national malaria treatment guidelines. In Ethiopia, the national treatment guidelines employ a species-specific approach. Artemether-lumefantrine (AL) and chloroquine (CQ) are the first-line schizonticidal treatments for Plasmodium falciparum and Plasmodium vivax, respectively. The National Malaria Control and Elimination Programme in Ethiopia is considering dihydroartemisinin-piperaquine (DHA/PPQ) as an alternative regimen for P. falciparum and P. vivax., Methods: The study assessed the clinical and parasitological efficacy of AL, CQ, and DHA/PPQ in four arms. Patients over 6 months and less than 18 years of age with uncomplicated malaria mono-infection were recruited and allocated to AL against P. falciparum and CQ against P. vivax. Patients 18 years or older with uncomplicated malaria mono-infection were recruited and randomized to AL or dihydroartemisinin-piperaquine (DHA/PPQ) against P. falciparum and CQ or DHA/PPQ for P. vivax. Patients were followed up for 28 (for CQ and AL) or 42 days (for DHA/PPQ) according to the WHO recommendations. Polymerase chain reaction (PCR)-corrected and uncorrected estimates were analysed by Kaplan Meier survival analysis and per protocol methods., Results: A total of 379 patients were enroled in four arms (n = 106, AL-P. falciparum; n = 75, DHA/PPQ- P. falciparum; n = 142, CQ-P. vivax; n = 56, DHA/PPQ-P. vivax). High PCR-corrected adequate clinical and parasitological response (ACPR) rates were observed at the primary end points of 28 days for AL and CQ and 42 days for DHA/PPQ. ACPR rates were 100% in AL-Pf (95% CI: 96-100), 98% in CQ-P. vivax (95% CI: 95-100) at 28 days, and 100% in the DHA/PPQ arms for both P. falciparum and P. vivax at 42 days. For secondary endpoints, by day three 99% of AL-P. falciparum patients (n = 101) cleared parasites and 100% were afebrile. For all other arms, 100% of patients cleared parasites and were afebrile by day three. No serious adverse events were reported., Conclusion: This study demonstrated high therapeutic efficacy for the anti-malarial drugs currently used by the malaria control programme in Ethiopia and provides information on the efficacy of DHA/PPQ for the treatment of P. falciparum and P. vivax as an alternative option., (© 2022. The Author(s).)

Using random germline mutagenesis in mice, we identified a viable hypomorphic allele (boh) of the transcription-factor-encoding gene Ovol2 that resulted in obesity, which initially developed with normal food intake and physical activity but decreased energy expenditure. Fat weight was dramatically increased, while lean weight was reduced in 12-week-old boh homozygous mice, culminating by 24 weeks in massive obesity, hepatosteatosis, insulin resistance, and diabetes. The Ovol2 boh/boh genotype augmented obesity in Lep ob/ob mice, and pair-feeding failed to normalize obesity in Ovol2 boh/boh mice. OVOL2-deficient mice were extremely cold intolerant. OVOL2 is essential for brown/beige adipose tissue-mediated thermogenesis. In white adipose tissues, OVOL2 limited adipogenesis by blocking C/EBPα engagement of its transcriptional targets. Overexpression of OVOL2 in adipocytes of mice fed with a high-fat diet reduced total body and liver fat and improved insulin sensitivity. Our data reveal that OVOL2 plays dual functions in thermogenesis and adipogenesis to maintain energy balance., Competing Interests: Declaration of interests Z.Z., L.S., and B.B. are inventors on a patent related to these findings., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Basic Life Support is a level of medical care Applied to victims of life-threatening illnesses and injuries before professional help is provided. This study aimed to assess the knowledge, attitude, and practice toward Basic Life support in Graduating class of health science and medical students at Dilla university referral hospital., Method: ology: A cross-sectional study was conducted on graduating class students of Dilla University, college of medicine and health science from September 10/2021 to December 13/2021. A total of 167 participants were selected by a systematic random sampling technique. A bi-variable and multi-variable logistic regression analysis were carried out., Result: Among the study participants, 95 (56.9%) and 86(51.5%) have good knowledge and good practice towards basic life support respectively. Being trained for basic life support and advanced life support, exposure with the person in need of basic life support were found more knowledgeable with odd ratio of [AOR = 13.8, 95% CI (6.3-30.1)], [AOR = 27.7, 95% CI (6.4-119)] and [AOR = 15.7, 95% CI (6.6-37.5)]. Learning anesthesia increases knowledge about basic life support nearly two times [AOR = 1.8, 95% CI (o.4-9.5)] when compared to medicine., Conclusion: The findings of this study suggest that nearly half of health science students in our hospital lack adequate knowledge and skills in BLS. Training on basic life support and advanced life support, learning in anesthesia and medicine departments, and exposure to the person in need of basic life support were significantly associated with high knowledge. To increase knowledge of BLS standardized Training and assessments are recommended., (© 2022 The Authors.)

Objective: This study aimed to determine the frequencies and trends of Mycobacterium tuberculosis and rifampicin resistance among presumptive tuberculosis patients in Ethiopia, who were tested using the Xpert MTB/RIF assay between 2014 and 2021., Methods: Data were collected retrospectively from patient registries. Laboratory-based data were extracted from the national tuberculosis (TB) referral laboratory database. All patients referred to the National Tuberculosis Reference Laboratory (NTRL) for TB diagnosis from all over the country between March 1, 2014 and September 30, 2021, and tested using the Xpert MTB/RIF assay, were included. The extracted data were entered into a Microsoft Excel sheet and analyzed by Statistical Package for Social Sciences (SPSS) version 23., Results: Among a total of 13 772 individuals tested using the Xpert MTB/RIF assay, the majority (8223; 59.7%) were males, and 48.5% (6678) of the individuals were aged between 15 and 39 years. Mycobacterium tuberculosis (MTB) was detected in 17.0% (2347) of the examined individuals. Of the detected MTB cases, nearly 9.9% (233) were rifampicin resistant (RR-TB), while 24 (1.0%) were RR-intermediate. Among all RR-TB cases, more than half (125; 53.6%) were detected in males, and 105 were new TB cases. Extrapulmonary (EPTB) patients had a greater rate of rifampicin resistance (11.0%) than pulmonary (PTB) patients (9.6%)., Conclusion: The frequency of TB and RR-TB remains high in the study setting. RR-TB was found to have a statistically significant association with previous anti-TB medication treatment. As a result, improving treatment adherence in recognized instances could assist in preventing MTB and RR-TB cases., (© 2022 The Author(s).)

Background: Postoperative pain after a cesarean section has negative consequences for the mother during the postoperative period. Over the years, various postoperative pain management strategies have been used following cesarean section. Opioid-based analgesics and landmark approaches have negative side effects, while ultrasound-based regional analgesia necessitates resources and experience, but various wound infiltration adjuvants are innovative with few side effects and are simple to use. The efficacy and safety of each adjuvant, however, are unknown and require further investigation., Objective: This network meta-analysis is intended to provide the most effective wound infiltration drugs for postoperative management after cesarean section., Method: A comprehensive search will be conducted in PubMed/MEDLINE, Cochrane Library, Science Direct, CINHAL, and LILACS without date and language restrictions. All randomized trials comparing the effectiveness of wound infiltration drugs for postoperative pain management after cesarean section will be included. Data extraction will be conducted independently by two authors. The quality of studies will be evaluated using the Cochrane risk of bias tool, and the overall quality of the evidence will be determined by GRADEpro software., Discussion: The rate of postoperative acute and chronic pain is very high which has a huge impact on the mother, family, healthcare practitioners, and healthcare delivery. It is a basic human right to give every patient with postoperative pain treatment that is realistic in terms of resources, technique, cost, and adverse event profile., Systematic Review Registration: PROSPERO CRD42021268774., (© 2022. The Author(s).)

Background: There is limited information on the performance of the Xpert ® MTB/RIF test for diagnosis of smear-negative pulmonary tuberculosis (SNPT) and rifampicin resistance (RR) in the same-day diagnosis approach. The effects of sputum quality and other factors affecting the Xpert performance are also under-investigated., Objective: This study aimed to determine the performance of the Xpert ® MTB/RIF test for detection of SNPT and RR in the same-day diagnosis strategy and the effect of sputum quality and other factors on its performance., Methods: A cross-sectional study was conducted from August 2017 to January 2018 across 16 health facilities in Addis Ababa, Ethiopia. Two spot sputum samples were collected from 418 presumptive SNPT patients, tested with Xpert® MTB/RIF, then compared to tuberculosis culture. Additionally, culture isolates were tested for RR by BACTEC MGIT™ 960 drug susceptibility testing (DST) and MTBDRplus version 2., Results: The Xpert ® MTB/RIF test detected 24 (5.7%) SNPT cases, with a sensitivity of 92.3% (75.9% - 97.9%) and specificity of 99.2% (97.8% - 99.7%) compared with tuberculosis culture. Xpert ® MTB/RIF also detected three (11.58%) RR strains with 100.0% concordance with BACTEC MGIT™ 960 DST and MTBDRplus results. Three blood-stained SNPT samples were positive by Xpert (30.0%), which was 6.9 times higher compared to salivary sputum (odds ratio: 6.9, 95% confidence interval: 1.36-34.96, p = 0.020)., Conclusion: The performance of the Xpert ® MTB/RIF to detect SNPT and RR in same-day diagnosis is high. However, SNPT positivity varies among sputum qualities, and good sample collection is necessary for better test performance., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2022. The Authors.)

Background: The rise of drug-resistant tuberculosis (DR-TB) has presented a substantial challenge to the national tuberculosis (TB) control program. Understanding the epidemiology of pre-extensively drug-resistant tuberculosis (pre-XDR-TB) could help clinicians to adapt MDR-TB treatment regimens at an earlier stage. This study aimed to assess second-line anti-TB drug resistance among MDR-TB patients in Ethiopia using routine laboratory-based data., Methods: Laboratory-based cross-sectional data were collected from the national TB reference laboratory and seven regional tuberculosis culture laboratories in Ethiopia from July 2019 to March 2022. The required data, such as drug-susceptibility testing (DST) results and sociodemographics, were collected on a structured checklist from laboratory registration books and electronic databases. Data were entered into a Microsoft Excel spreadsheet and analyzed using SPSS version 23. Descriptive statistics were performed to show the distribution and magnitude of drug resistance., Results: Second-line drugs (SLDs) susceptibility testing was performed for 644 MDR isolates, of which 19 (3%) were found to be pre-XDR-TB cases. Of the total MDR-TB isolates, 19 (3%) were resistant to at least one fluoroquinolone drug, while 11 (1.7%) were resistant to at least one injectable second-line drug. Of the 644 MDR-TB isolates, 1.9% (5/261) pre-XDR were from new MDR-TB cases, while 3.7% (14/383) were from previously treated MDR-TB patients. The most frequently identified mutations, based on MTBDR sl results, were in codon A90V of the gyrA gene (77.3%) and A1401G of the rrs gene (45.5%)., Conclusion: The overall prevalence of pre-XDR-TB in Ethiopia is considerable. The majority of SLD resistance mutations were in the gyrA gene at position A90V . Modern, rapid DST is necessary to enable identification of pre-XDR-TB and XDR-TB in supporting proper regimen administration for patients., (© 2022 The Author(s).)

Background: Surgical site infections (SSIs) are infections that occur within 30 days of surgery or within 1 year in patients with implants at or around the surgical site. They are among the dangerous complications of surgical procedures that expose patients to higher costs and increase the risk of death because of severe morbidity and associated longer hospital stays. This study aimed to determine the extent and determinants of surgical site infections in surgically treated cases during the study period., Methods: A hospital-based cross-sectional study was conducted among surgically treated patients at Dilla University Referral Hospital in the surgical department. The calculated sample size was 408, calculated using the single population proportion formula, and the required information was collected from the medical records of the study participants using checklists. Bivariate logistic regression was performed to identify candidate variables, and all candidate variables with a P-value < of 0.25 were included in multivariable logistic regression. Variables with a P-value < 0.05 were considered statically significant, and the strength of association was measured by odds ratio (OR) with 95% confidence intervals (CIs)., Result: As our finding showed magnitude of surgical site infections was 19.3%. The factors which had significant association with surgical wound infections were blood transfusion (AOR = 0.16 (0.04-0.73), hemoglobin level < 7 g/dl (AOR = 10.40 (3.39-32.49), shock (AOR = 19.09 (4.69-77.51), previous surgery (AOR = 11.53(3.73-35.61), hospitalization 7-14 days (AOR = 5.51(1.52-19.91) and hospitalization >14 days (AOR = 8.18(1.84-36.75)., Conclusion: The percentage of surgical site infections was high. Shock, low haemoglobin level, blood transfusion, previous surgery, and longer length of hospital stay were significantly related to surgical site infections., Competing Interests: None, (© 2022 The Authors.)

Background: The most frequent obstetric surgery both in Ethiopia and around the world is the cesarean section (CS). Postoperative pain that is not well managed can have a major negative impact on surgical patient morbidity, delaying healing and the return to normal daily activities. Even though the cesarean section is one of the most commonly performed operations, postoperative pain after cesarean section and associated factors has not been studied., Objective: To assess the magnitude and factors associated with postoperative pain after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia., Methods: From February 1 to September 30 in 2021, a hospital-based cross-sectional study was undertaken among women who underwent cesarean deliveries at Hawassa University Comprehensive Specialized Hospital. The patient's medical file was read, and information was gathered from them using a structured questionnaire and checklist. The information was prepared for analysis by being cleaned, coded, and put into EPI Data version 3.1 before being exported to SPSS version 20. The prevalence rate and socio-demographic details were displayed using descriptive statistics. Bivariate and multivariable logistic regression analysis was done to identify the associated factors. Variables with a p-value of <0.05 were considered statistically significant., Results: The magnitude of moderate to severe post-operative pain after a cesarean section was 89.8% (95% CI 84.7, 93.5). Duration of procedure (AOR: 3.62, 95% CI: 1.33, 15.85), type of anesthesia (AOR: 2.38, 95% CI: 1.31, 8.71), and type of analgesics administered (AOR: 2.3, 95% CI: 1.28, 19.21) were significantly associated with moderate to severe post-operative pain., Conclusion: In this study a significant number of parturient in this study reported moderate to severe post-cesarean pain within 24 h. The duration of the procedure, the type of anesthesia used, and the type of analgesics administered were all found to be significantly associated with postoperative pain after cesarean section., Competing Interests: All authors declare that they do not have any conflicts of interest., (© 2022 The Authors.)