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Human African trypanosomiasis (HAT), also known as African sleeping sickness, is caused by different subspecies of the blood parasite Trypanosoma brucei. T. brucei rhodesiense mainly affects livestock and wildlife but [...]

Introduction: The use of unimproved energy sources is associated with a range of health problems. However, in Ethiopia, studies focused on the utilization of unimproved energy sources and associated factors are limited. Therefore, this study aimed to close this gap. Methods: In this community-based cross-sectional study, 5,350 participants were enrolled. Multivariable logistic regression analyses were employed to examine the associations between the utilization of unimproved energy sources and the predictor variables. Additionally, the chi-square test was used to examine the association between households' unimproved energy source utilization and the occurrence of health problems. Results: In this study, 45% of households used unimproved energy sources. In the multivariable analysis, households headed by men (adjusted odds ratio [AOR] = 0.76; with 95% confidence interval [CI] 0.66, 0.87), households headed by illiterate heads (AOR = 1.77 with 95% CI 1.47, 2.14), household family size (AOR = 0.79 with 95% CI 0.79, 0.93), households headed with farmers (AOR = 3.33 with 95% CI 2.31, 4.81), households with low income (AOR = 3.41 with 95% CI 2.57, 4.51), rural households (AOR = 7.94 with 95% CI 6.76, 9.32), and households with regular coffee ceremony practices (AOR = 1.17 with 95% CI 1.00, 1.36) were significantly associated with the utilization of unimproved energy sources. Additionally, the results of the chi-square test revealed that households that relied on unimproved energy sources had a 1.5-fold greater risk of developing respiratory illnesses, an 8.5-fold greater risk of developing cataract disease, and a 5.2-fold greater risk of developing trachoma than households that used improved energy sources. Conclusion: A significant proportion of households in Bishoftu town still rely on unimproved energy sources for cooking and other household needs. This indicates a substantial challenge in achieving universal access to clean and sustainable energy in the area. Several socioeconomic and demographic factors are associated with the use of unimproved energy sources, including male-headed households, illiteracy of household head, smaller family size, farming occupation, low income, rural residence, and regular coffee ceremony practices. Most importantly, the use of unimproved energy sources is associated with higher risks of respiratory illnesses, cataracts, and trachoma among household members. Therefore, the government should implement targeted interventions to promote the adoption of clean and improved energy sources among vulnerable households such as households headed by farmers, those with illiterate heads, households with low socioeconomic status, households with regular coffee ceremony practices, and those in rural areas. In addition, the local government should develop and implement educational campaigns to raise awareness about the health and environmental risks associated with the use of unimproved energy sources, particularly among households with high-risk factors identified in the study. Highlights: ➣ Nearly half of households in Bishoftu use harmful energy sources for cooking. ➣ Utilization of unimproved energy use links to serious health issues like respiratory diseases, Trachoma and cataracts. ➣ Many determinant factors influencing households' utilization of unimproved energy sources were identified. ➣ Targeted education and support are needed to promote clean energy adoption in vulnerable communities. [ABSTRACT FROM AUTHOR]

Background: This paper documents changes in the prevalence and intensity of soil-transmitted helminth (STH) infections in the Geshiyaro project in the Wolaita zone of Southern Ethiopia. Methods: The Geshiyaro project comprises three intervention arms. Arm 1 is subdivided into the Arm 1 pilot (one district) and Arm 1 (four other districts), both receiving integrated community-wide mass drug administration MDA (cMDA) with intensive water, sanitation, and hygiene (WaSH) interventions. Arm 2 involves 18 districts with cMDA interventions plus the existing government-led One WaSH program, while Arm 3 serves as a control with school-based MDA (sMDA) interventions plus the existing government-led One WaSH program in three districts. The study is designed as a cohort investigation over time, with the establishment of longitudinal sentinel sites where infection levels are assessed annually. A total of 45 longitudinal parasitological surveillance sentinel sites are being used across all three intervention arms to monitor STH prevalence and intensity of infection. From each of the 45 sentinel sites, 150 individuals were randomly selected, stratified by age and gender. The t-test and analysis of variance (ANOVA) were employed to compare infection prevalence and intensity across the three study arms over time. Results: The prevalence of STH decreased significantly from 34.5% (30.6%, 38.5%) in 2019 to 10.6% (8.3%, 13.4%) in 2022/2023 (df = 1, P < 0.0001) in the Arm 1 pilot, from 27.4% (25.2%, 29.7%) in 2020 to 5.5% (4.4%, 6.7%) in 2023 (df = 1, P < 0.0001) in Arm 1, from 23% (21.3%, 24.8%) in 2020 to 4.5% (3.7%, 5.3%) in 2023 (df = 1, P < 0.001) in Arm 2, and from 49.6% (47.4%, 51.7%) in 2021 to 26.1% in 2023 (df = 1, P < 0.0001) in Arm 3. The relative reduction in the prevalence of any STH was the highest in the arms employing cMDA, namely Arm 2, with a decrease of 82.5% (79.3%, 84.2%), followed by Arm 1 with a reduction of 80.1% (75.3%, 84.6%), and then the Arm 1 pilot with a decrease of 69.4% (60.1%. 76.6%). Arm 3 employing sMDA had the lowest decrease, with a reduction of 46.9% (43.6%, 51%). The mean intensity of infection (based on Kato–Katz egg count measures) for Ascaris lumbricoides species, which was the dominant STH species present in the study area, decreased significantly in Arms 1 and 2, but only slightly in Arm 3. The prevalence of hookworm and Trichuris trichiura infections were found to be very low in all arms but also decreased significantly. Conclusions: The reduction in the prevalence and intensity of STH in Arms 1 and 2 revealed steady progress towards transmission interruption based on cMDA intervention, but additional efforts with MDA coverage and WaSH interventions are needed to achieve a prevalence threshold < 2% based on the quantitative polymerase chain reaction (qPCR) diagnostic method. [ABSTRACT FROM AUTHOR]

Background: Access to basic sanitation services is essential to enhance public health and well-being. However, ensuring adequate sanitation coverage is difficult in many parts of Ethiopia, including the Geshiyaro Project implementation sites. The Geshiyaro project is part of monitoring and evaluation activities aimed at assessing access to water and basic sanitation services. Hence, research on access to basic sanitation services and the associated risk factors in the Geshiyaro project sites is lacking. Thus, the purpose of this study was to fill this gap. Methods: A community-based cross-sectional study was conducted from June to July 2023. A total of 7995 households were included in this study. A structured questionnaire was used to collect the data. STATA version 16 was used to conduct both descriptive and multivariable analysis. Results: The study reported that 8.4% of households had basic sanitation services. The following factors were significantly associated with the availability of basic sanitation services: residence (AOR = 0.31, 95% CI 0.25–0.37), education (AOR = 1.36, 95% CI 1.12–1.66), occupation (AOR = 0.44, 95% CI 0.33–0.57), annual income (AOR = 0.66, 95% CI 0.55–0.80), age (AOR = 1.77, 95% CI 1.10–2.84), awareness creation about WASH services (AOR = 0.58, 95% CI 0.49–0.70), family size (AOR = 1.22, 95% CI 1.01–1.46), and water source type (AOR = 0.27, 95% CI 0.13–0.57). Conclusion: Households' access to basic sanitation services in Ethiopia's Geshiyaro project site is a significant public health concern. Many factors that affect access to basic sanitation services have been identified. The study highlights the importance of targeted interventions to address sociodemographic disparities and improve sanitation facilities. Similarly, the findings of this research will contribute to the achievement of Sustainable Development Goals (SDG) target 3.3 to eradicate the epidemics of AIDS, neglected tropical diseases, tuberculosis, and malaria, as well as combat hepatitis and water-borne illnesses and Sustainable Development Goals (SDG) target 6.2, which deal with the elimination of open defecation, access to sufficient and equitable sanitation and hygiene for everyone, and reducing infectious diseases. [ABSTRACT FROM AUTHOR]

Background: Malaria remains a major global health problem although there was a remarkable achievement between 2000 and 2015. Malaria drug resistance, along with several other factors, presents a significant challenge to malaria control and elimination efforts. Numerous countries in sub-Saharan Africa have documented the presence of confirmed or potential markers of partial resistance against artemisinin, the drug of choice for the treatment of uncomplicated Plasmodium falciparum malaria. The World Health Organization (WHO) recommends regular surveillance of artemisinin therapeutic efficacy to inform policy decisions. Methods: This study aimed to evaluate the therapeutic efficacy of artemether-lumefantrine (AL), which is the first-line treatment for uncomplicated P. falciparum malaria in Ethiopia since 2004. Using a single-arm prospective evaluation design, the study assessed the clinical and parasitological responses of patients with uncomplicated P. falciparum malaria in Metehara Health Centre, central-east Ethiopia. Out of 2332 malaria suspects (1187 males, 1145 females) screened, 80 (50 males, 30 females) were enrolled, followed up for 28 days, and 73 (44 males, 29 females) completed the follow up. The study was conducted and data was analysed by employing the per-protocol and Kaplan–Meier analyses following the WHO Malaria Therapeutic Efficacy Evaluation Guidelines 2009. Results: The results indicated rapid parasite clearance and resolution of clinical symptoms, with all patients achieving complete recovery from asexual parasitaemia and fever by day (D) 3. The prevalence of gametocytes decreased from 6.3% on D0 to 2.5% on D2, D3, D7, and ultimately achieving complete clearance afterward. Conclusion: The overall cure rate for AL treatment was 100%, demonstrating its high efficacy in effectively eliminating malaria parasites in patients. No serious adverse events related to AL treatment were reported during the study, suggesting its safety and tolerability among the participants. These findings confirm that AL remains a highly efficacious treatment for uncomplicated P. falciparum malaria in the study site after 20 years of its introduction in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: Open defecation is a significant global challenge, impacting public health, environmental sanitation, and social well-being, especially in low- and middle-income countries like Ethiopia. It is the second-largest cause of disease burden worldwide by facilitating the spread of germs that cause diarrhea diseases. Studies examining open defecation practices are insufficient, especially in areas implementing Ethiopia's Geshiyaro project. Therefore, this study aimed to assess the status of open defecation practice and associated factors in the study area. Method: A community-based cross-sectional study was conducted from June to July 2023. The total number of households included in this study was 7995. A structured questionnaire and observational checklist were used to collect data. Descriptive and multivariate logistic regression analyses were performed using STATA version 16. Results: The study found that 16.5% of households practiced open defecation. The following factors were significantly associated with the occurrence of open defecation: residence (AOR = 1.56, 95% CI: 1.26-1.92), education (AOR = 0.59, 95% CI: 0.49-0.72), age (AOR = 0.53, 95% CI: 0.41-0.69), knowledge on diarrhea prevention (AOR = 1.32, 95% CI: 1.17-1.50), marital status (AOR = 1.61, 95% CI: 1.32-1.97), and awareness creation about WASH services (AOR = 1.96, 95% CI: 1.71-2.25). On the other hand, no significant association was observed between the occurrence of open defecation and the household's income (AOR = 1.07, 95% CI: 0.93-1.23) or the head of household sex (AOR = 0.94, 95% CI: 0.78-1.12). Conclusion: Open defecation remains a critical public health concern in Ethiopia's Geshiyaro project sites. Various factors influencing this practice have been identified. Targeted interventions are needed to enhance access to safe sanitation facilities and promote awareness of WASH services, aligning with SDG 3 target 3, and SDG 6 target 2. [ABSTRACT FROM AUTHOR]

Background: This paper describes changes in the prevalence and intensity of schistosome parasite infections in a project integrating mass drug administration (MDA), water, sanitation, and hygiene (WaSH), and behavioral change interventions. Methods: The Geshiyaro Project comprises three intervention arms. Arm 1 is subdivided into "Arm 1 pilot" (one district) and Arm 1 (four other districts), both receiving integrated community-wide MDA with intensive WaSH interventions. Arm 2 involves 17 districts with community-wide MDA interventions, while Arm 3 serves as a control with school-based MDA interventions in three districts. A total of 150 individuals, stratified by age group, were randomly selected from each of the 45 sentinel sites. Arm sizes were 584 (Arm 1 pilot), 1636 (Arm 1), 2203 (Arm 2), and 2238 (Arm 3). Statistical tests were employed to compare infection prevalence and intensity across the different arms. Results: The prevalence of schistosome parasite infection ranged from 0% to 2.6% and from 1.7% to 25.7% across districts, employing the Kato-Katz (KK) and point-of-care circulating cathodic antigen (POC-CCA) diagnostics, respectively. The mean infection intensity level showed no marked difference between baseline and follow-up surveys when measured by KK, except in Arm 2 (t = 6.89, P < 0.0001). Infection prevalence decreased significantly in Arm 1 (t = 8.62, P < 0.0001), Arm 2 (t = 6.94, P < 0.0001), and Arm 3 (t = 8.83, P < 0.0001), but not in Arm 1 pilot (t = 1.69, P = 0.09) by POC-CCA, when trace was considered positive. The decrease was significant only in Arm 1 (t = 3.28, P = 0.0001) and Arm 2 (t = 7.62, P < 0.0001) when the trace was considered negative in POC-CCA. Arm 2 demonstrated a significant difference in difference (DID) compared to the control group, Arm 3, regardless of whether trace in POC-CCA was considered positive (DID = 3.9%, df = 8780, P = 0.025) or negative (DID = −5.2, df = 8780, P = 0.0004). Conclusions: The prevalence of schistosomiasis was low when employing the KK diagnostic but moderate in some locations by the POC-CCA diagnostic. The infection level had decreased across all arms of the Geshiyaro study at mid-term of the 7-year project, but further efforts are needed to reduce the rate of parasite transmission based on the POC-CCA diagnostic scores. [ABSTRACT FROM AUTHOR]

Introduction: Although wastewater-based epidemiology (WBE) successfully functioned as a tool for monitoring the coronavirus disease 2019 (COVID-19) pandemic globally, relatively little is known about its utility in low-income countries. This study aimed to quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater, estimate the number of infected individuals in the catchment areas, and correlate the results with the clinically reported COVID-19 cases in Addis Ababa, Ethiopia., Methods: A total of 323 influent and 33 effluent wastewater samples were collected from three Wastewater Treatment Plants (WWTPs) using a 24-h composite Moore swab sampling method from February to November 2023. The virus was captured using Ceres Nanotrap® Enhancement Reagent 2 and Nanotrap® Microbiome A Particles, and then nucleic acids were extracted using the Qiagen QIAamp Viral RNA Mini Kit. The ThermoFisher TaqPath™ COVID-19 kit was applied to perform real-time reverse transcriptase polymerase chain reaction (qRT-PCR) to quantify the SARS-CoV-2 RNA. Wastewater viral concentrations were normalized using flow rate and number of people served. In the sampling period, spearman correlation was used to compare the SARS-CoV-2 target gene concentration to the reported COVID-19 cases. The numbers of infected individuals under each treatment plant were calculated considering the target genes' concentration, the flow rate of treatment plants, a gram of feces per person-day, and RNA copies per gram of feces., Results: SARS-CoV-2 was detected in 94% of untreated wastewater samples. All effluent wastewater samples ( n  = 22) from the upflow anaerobic sludge blanket (UASB) reactor and membrane bioreactor (MBR) technology were SARS-COV-2 RNA negative. In contrast, two out of 11 effluents from Waste Stabilization Pond were found positive. Positive correlations were observed between the weekly average SARS-CoV-2 concentration and the cumulative weekly reported COVID-19 cases in Addis Ababa. The estimated number of infected people in the Kality Treatment catchment area was 330 times the number of COVID-19 cases reported during the study period in Addis Ababa., Discussion: This study revealed that SARS-CoV-2 was circulating in the community and confirmed previous reports of more asymptomatic COVID-19 cases in Ethiopia. Additionally, this study provides further evidence of the importance of wastewater-based surveillance in general to monitor infectious diseases in low-income settings., Conclusion: Wastewater-based surveillance of SARS-CoV-2 can be a useful method for tracking the increment of COVID-19 cases before it spreads widely throughout the community., 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 Abera Dinssa, Gebremicael, Mengistu, Hull, Chalchisa, Berhanu, Gebreegziabxier, Norberg, Snyder, Wright, Gobena, Abera, Belay, Chala, Gizaw, Getachew, Tesfaye, Tefera, Belachew, Mulu, Ali, Kebede, Melese, Abdella, Rinke de Wit, Kebede, Hailu, Wolday, Tessema and Tollera.)

Background: Community-wide mass drug administration (cMDA) is known as an effective, albeit costly, control strategy for soil-transmitted helminth (STH) parasites. A better understanding of STH aggregation after many rounds of cMDA could help shape more cost-effective policies., Methods: This analysis uses data from the Geshiyaro project, aiming to break STH transmission by cMDA and water, sanitation and hygiene interventions. Ascaris lumbricoides infection prevalence is derived from egg count data and parasite aggregation is obtained by fitting a negative binomial distribution to the frequency distribution of faecal egg counts., Results: The relationship between parasite dispersion and infection prevalence is approximately linear. Parasite aggregation increases as infection prevalence decreases., Conclusions: A minority of individuals carry most parasites as prevalence decreases in the community. These individuals could be selectively targeted for repeated treatment., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

In Ethiopia, dengue virus (DENV) infections have been reported in several regions, however, little is known about the circulating genetic diversity. Here, we conducted clinical surveillance for DENV during the 2023 nationwide outbreak and sequenced DENV whole genomes for the first time in Ethiopia. We enrolled patients at three sentinel hospital sites. Using RT-PCR, we screened serum samples for three arboviruses followed by serotyping and sequencing for DENV-positive samples (10.4% of samples). We detected two DENV serotypes (DENV1 and DENV3). Phylogenetic analysis identified one transmission cluster of DENV1 (genotype III major lineage A), and two clusters of DENV3 (genotype III major lineage B). The first showed close evolutionary relationship to the 2023 Italian outbreak and the second cluster to Indian isolates. Co-circulation of DENV1 and DENV3 in some regions of Ethiopia highlights the potential for severe dengue. Intensified surveillance and coordinated public health response are needed to address the threat of severe dengue outbreaks.

Background: This study aimed to enhance insights into the key characteristics of maternal and neonatal mortality declines in Ethiopia, conducted as part of a seven-country study on Maternal and Newborn Health (MNH) Exemplars., Methods: We synthesised key indicators for 2000, 2010 and 2020 and contextualised those with typical country values in a global five-phase model for a maternal, stillbirth and neonatal mortality transition. We reviewed health system changes relevant to MNH over the period 2000-2020, focusing on governance, financing, workforce and infrastructure, and assessed trends in mortality, service coverage and systems by region. We analysed data from five national surveys, health facility assessments, global estimates and government databases and reports on health policies, infrastructure and workforce., Results: Ethiopia progressed from the highest mortality phase to the third phase, accompanied by typical changes in terms of fertility decline and health system strengthening, especially health infrastructure and workforce. For health coverage and financing indicators, Ethiopia progressed but remained lower than typical in the transition model. Maternal and neonatal mortality declines and intervention coverage increases were greater after 2010 than during 2000-2010. Similar patterns were observed in most regions of Ethiopia, though regional gaps persisted for many indicators. Ethiopia's progress is characterised by a well-coordinated and government-led system prioritising first maternal and later neonatal health, resulting major increases in access to services by improving infrastructure and workforce from 2008, combined with widespread community actions to generate service demand., Conclusion: Ethiopia has achieved one of the fastest declines in mortality in sub-Saharan Africa, with major intervention coverage increases, especially from 2010. Starting from a weak health infrastructure and low coverage, Ethiopia's comprehensive approach provides valuable lessons for other low-income countries. Major increases towards universal coverage of interventions, including emergency care, are critical to further reduce mortality and advance the mortality transition., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)