Search

Background The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). Conclusions ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registration ClinicalTrials gov NCT03853824.

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

Introduction: Postnatal care is a care provided to women and their babies within 42 days after deliveryA large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery, and these first two days following delivery are critical for monitoring complications arising from the delivery World Health Organization (WHO) recommends that after an uncomplicated vaginal birth in a health facility, healthy mothers newborns should receive care in the facility for at least 24 hours after birth. If birth is at home, the first postnatal contact should be as early as possible within 24 hours of birth. Objective: To assess prevalence and associated factors of postnatal care utilization among women attending immunization clinics in health centers, Hawassa city, southern Ethiopia, 2019. Methodology: Institution based cross sectional study design was done. Study was conducted in all health centers .The total sample sizes were 306 women attending immunization clinic at health centers A random sampling technique was employed to select the study subjects. Data collection was conducted from study subjects using pretest questioners. The questioner was developed in English. Ethical clearance was obtained from the research unit of Rift Valley University. Data was entered and analyzed using SPSS version 20 for windows. Frequency distribution table and statically graph were used to describe the variables of interest. The associated factors of postnatal care utilization were identified using bivariate and multivariate analysis. Result: Multi parous women who had PNC experience were three times more likely to utilize PNC service for the current delivery than those primi Para women[ AOR=2.8, 95% CI (1.36-5.8)]. On the other hand, those multi parous women who hadn’t PNC experience were almost 50% less likely to utilize PNC for the current delivery than those primi Para women[AOR=0.43, 95% CI (0.20-0.92)]. Finally, those women who were discharged from the institution after delivery at less than 6 hrs of stay were almost 80% less likely to utilize PNC than those women who stayed more than 24hrs [AOR= 0.22, 95% CI (0.06-0.83)]. Conclusion: The overall prevalence of PNC service utilization in this study was relatively good as compared to the HSDP IV report for Hawassa city in the 2006 EFY. PNC counseling and provision of appointment, counseling on danger sign, past experience of PNC utilization, and less than 6 hours stay at health institution before discharge were found to statistically significant for the current PNC service Utilization

Background: Globally 1.13 billion peoples were living with hypertension, Out of this two-thirds of them were living in low and middle-income countries. In Ethiopia, Non Communicable Disease deaths are estimated at around 42%. However, it remain widely undetected and poorly controlled. To resolve these, lifestyle modification approach that often overlooked are corner stone of the prevention and management of hypertension.Objective: To assess lifestyle modification practice and associated factors among hypertensive patients in selected hospitals in West Arsi Zone, Oromia Regional, Ethiopia December 7 to 21, 2019.Method: Hospital-based cross-sectional study was conducted in the selected public hospital among 299 hypertensive patients. Systemic random sampling method were used to select the study participants. Data were collected by face-to-face interviews using a structured questionnaire by trained data collectors. Data were analyzed using descriptive statistics and multivariate logistic regression method to identify predictors of the outcome (pResults: Of the total participants, only 25.2% (95% CI: 18.8-32.9) of the patients were practice recommended lifestyle modifications. Patients Age older than 65 years (AOR=2.9, 95% CI: 1.17-7.0), the patients with 2-5 years’ time since diagnoses hypertension (AOR=0.26, 95%CI: 0.07-0.9), multiple co-morbidity (AOR=2.7, 95% CI: 1.25-5.8) and their knowledge on hypertension management (AOR=14.6, 95% CI: 4.6-45.9) have an independently associated with recommended lifestyle modification.Conclusion: Lifestyle modification practices among hypertensive patients were low in this study. Age, comorbidity, time since diagnoses of hypertension and knowledge of lifestyle were identified as predictors of the outcome.

Solomon Berhanu Mogas,1 Temamen Tesfaye,2 Belay Zewde,3 Yonas Tesfaye,4 Ayantu Kebede,1 Mulualem Tadesse,5 Esayas Kebede Gudina,6 Dessalegn Tamiru,7 Lelisa Sena Dadi1 1Department of Epidemiology, Jimma University, Jimma, Oromia Region, Ethiopia; 2School of Nursing and Midwifery, Jimma University, Jimma, Oromia Region, Ethiopia; 3Department of Biomedical Sciences, Jimma University, Jimma, Oromia Region, Ethiopia; 4Department of Psychiatry, Jimma University, Jimma, Oromia Region, Ethiopia; 5School of Medical Laboratory Science, Jimma University, Jimma, Oromia Region, Ethiopia; 6Department of Internal Medicine, Jimma University, Jimma, Oromia Region, Ethiopia; 7Department of Nutrition and Dietetics, Jimma University, Jimma, Oromia Region, EthiopiaCorrespondence: Solomon Berhanu MogasDepartment of Epidemiology, Jimma University, P.O.Box-378, Oromia Region, EthiopiaTel +251913458961Email solo.berhanu@gmail.comBackground: Hypertension (HTN) is the leading risk factor for mortality due to cardiovascular diseases, it accounts for 7% of global disability adjusted life years. In 2015, it was estimated that around 1.13 billion adults had HTN globally with a high prevalence in low and middle-income countries where the health system is weak to diagnose, treat, and control HTN. Most people with HTN are asymptomatic and go undiagnosed for years. Therefore, the aim of this study was to assess the burden of undiagnosed HTN among adults in urban communities of Southwest Ethiopia.Methods: A community-based cross-sectional study involving 915 adults from June 17 to July 27, 2019 was performed. WHO STEPS questionnaire was used to collect data, and the collected data were entered using Epi Data version 3.1and analyzed using SPSS version 20, respectively. Binary logistic regression was used to check for a possible association between outcome and independent factors. P-value < 0.05 and 95% CI were used on multivariable logistic regression analysis as threshold for significant statistical association.Results: Undiagnosed HTN in the study area was 21.2% (194). Age (AOR=1.04, 95% CI=1.02– 1.05), BMI with overweight (AOR=2.52, 95% CI=1.35– 4.71), triglyceride (AOR=1.83, 95% CI=1.29– 2.59), and waist to hip ratio (AOR=1.62, 95% CI=1.03– 2.54) were factors significantly associated with HTN.Conclusion: As compared to studies performed before, the risk of undiagnosed HTN in the current study was high. Age, BMI, triglyceride, and waist to hip ratios were found to be the significant factors for it. Preventing the risk factors and screening of HTN should be promoted for early detection, prevention, and treatment of the burden of the disease on the population.Keywords: adult, burden, Ethiopia, hypertension, Jimma town, risk, undiagnosed

Background Antimicrobial resistance is one of the major public health challenges in Ethiopia. However, there is no comprehensive summary of existing AMR data in the country. Aim To determine the prevalence of antimicrobial resistance and its clinical implications in Ethiopia. Methods A systematic literature search was performed on the PubMed/Medline database. Original studies on antimicrobial resistance conducted in Ethiopia between 1st January 2009 and 31st July 2019 were included. The outcome measure was the number of isolates resistant to antimicrobial agents in terms of specific pathogens, and disease condition. Data was calculated as total number of resistant isolates relative to the total number of isolates per specific pathogen and medication. Results A total of 48,021 study participants enrolled from 131 original studies were included resulting in 15,845 isolates tested for antimicrobial resistance. The most common clinical sample sources were urine (28%), ear, nose, and throat discharge collectively (27%), and blood (21%). All the studies were cross-sectional and 83% were conducted in hospital settings. Among Gram-positive bacteria, the reported level of resistance to vancomycin ranged from 8% (Enterococcus species) to 20% (S. aureus). E. coli, K. pneumoniae and P. aeruginosa were the most common Gram-negative pathogens resistant to key antimicrobial agents described in the national standard treatment guideline and were associated with diverse clinical conditions: urinary tract infections, diarrhea, surgical site infections, pneumonia, ocular infections, and middle ear infections. Conclusion Overall, there is a high prevalence of antimicrobial resistance in Ethiopia. Empirical treatment of bacterial infections needs to be guided by up-to-date national guidelines considering local antimicrobial susceptibility patterns. Equipping diagnostic laboratories with culture and drug susceptibility testing facilities, and establishing a strong antimicrobial stewardship program should be high priorities.

Introduction: Traumatic brain injury is a major global public health problem causing substantial mortality among the adult population. Hence, this study aimed to determine the predictors of mortality among adult traumatic brain injury patients in Felegehiwot Comprehensive Specialized Hospital in Northwest Ethiopia during 2020. Methods: A retrospective cohort study was conducted at Felegehiwot Comprehensive Specialized Hospital using anonymized patient data obtained from chart review. Descriptive statistics were used to summarise the patient characteristics. The Kaplan–Meier survival curve and log-rank test were used to test for differences in survival status among groups. The Cox proportional hazards regression model was used at the 5% level of significance to determine the net effect of each explanatory variable on time to death. Results: In total, 338 patients aged ≥15 years and diagnosed with traumatic brain injury were included in the analysis. Among these patients, 103 (30.45%) died, giving a crude death rate of 25.53 per 1000 (95% CI: 21.05–30.98) person-days of follow-up. The overall median survival time was 44 days. The independent predictors of mortality after diagnosis of traumatic brain injury were admission Glasgow coma scale score ≤ 8 (adjusted hazard ratio (AHR): 4.85; 95% confidence interval (CI): 1.73–13.62), bilateral non-reactive pupils at admission (AHR: 2.00 (95% CI: 1.10–3.71), elevated systolic blood pressure at admission (AHR: 0.31; 95% CI:0.11–0.86), elevated diastolic blood pressure at admission (AHR: 3.54; 95% CI: 1.33–9.43), and haematoma evacuation (AHR: 0.42; 95% CI: 0.16–0.90). Discussion: The Survival status of traumatic brain injury patients was relatively low in this study. Glasgow coma scale score, bilateral non-reactive pupils, and elevated blood pressure were significant predictors of mortality. Further prospective follow-up studies that include residence and occupation are recommended.

Purpose This paper aims to interpret the role and professional issues of public sector performance auditing (PA) as a mechanism of neoliberal governmentality in the New Public Management (NPM) era by drawing on a Foucauldian conceptual lens to chart directions for future research. Design/methodology/approach The study uses the Foucauldian concepts of visibility and identity to interpret PA against the background of neoliberal imperatives of public sector management. Findings As the growing emphasis on PA in recent decades can be understood as driven by the concurrent development of neoliberal and NPM rationalities, the relatively underexploited concepts of visibility and identity allow further inquiry into important PA issues. This paper identifies avenues for future research under the following three themes: the issue of visibility in neoliberal governmentality and potential for auditors-general to expand the domain of influence of National Audit Offices through the PA role; the potential for PA as a unified distinct specialisation; and the neoliberal idea of professional identity as the individual expert and its interplay with the potential emergence of PA as a distinct function within the accounting profession. Research limitations/implications This conceptual paper is anticipated to stimulate future PA research. Key areas in this respect include the position and authority afforded to PA and the possibility of transformation in auditors’ conception of their professional worldview. Originality/value This paper charts direction for future research by interpreting PA using Foucauldian concepts of visibility and identity that remain to be exploited in PA research.

Background Spontaneous globe subluxation (SGS) is an atraumatic anterior dislocation of the eyeball. It is exceedingly rare. Understanding SGS predisposing factors may help uncover its etiology and undertake vision-saving management. Case presentation A 48-year-old female presented to the ED with her right eye out of its socket. She reported blurry vision, photophobia, and pain in the affected eye. She was unable to close her right eyelid and was in obvious distress. On arrival, her blood pressure was elevated. Her medical history was notable for hypertension and obesity. On physical examination, extraocular eye movements were not intact, and the globe appeared whole and round. She was also unable to count fingers with the affected eye. There was no visible trauma to the face. Multiple wet gauzes with sterile saline were placed over the displaced eyeball. Direct and even pressure was applied on the globe. Within 30 s, the globe was reduced back in. The patient was able to close her eyelids and reports substantial pain relief with reduction. A CT scan of the orbits was then obtained, demonstrating mild bilateral proptosis. The globes were normal and symmetric. No intraconal or extraconal abscess or infection was seen. There were no intraconal or extraconal masses. There was no acute orbital traumatic injury, no avulsion of the optic nerve, ocular rupture, or retrobulbar hematoma. After reviewing the case with an ophthalmologist, a follow-up appointment with the ophthalmologist was arranged. The patient was discharged on erythromycin ointment. Post-discharge investigation of the CT imaging revealed dilated optic nerve sheaths, tortuosity of the optic nerve, and empty sella. Conclusions In addition to causing distress and severe anxiety, SGS poses numerous immediate as well as long-term complications. Traction of the optic nerve and retinal vasculature may potentially cause retinal venous congestion and loss of visual acuity with potential vision loss. In the absence of known risk factors or disease processes, orbital imaging and serological studies for thyroid ophthalmopathy should be considered.

Background. Bovine rotavirus (BRV) and bovine coronavirus (BCoV) are the most common viral agents in neonatal calf diarrhea and result in serious economic consequences. The aim of the study was to determine the epidemiology of those viruses in randomly selected dairy farms of Addis Ababa. Methods. A cross-sectional study was conducted from November 2018 to April 2019 using a probability proportional to size (PPS) sampling technique. A total of 110 calves, less than 30 days of age, from 57 dairy herds were involved in the study. Associated factors of herds and calves were collected using semistructured interviews from farm owners and through physical observation of selected calves. Fecal samples were collected and analyzed using the sandwich ELISA method. Data generated from both semistructured interviews and laboratory investigation were analyzed using STATA_MP version 15. Results. From the total 110 calves, 42 (38.18%) had diarrhea during the survey. The prevalence of bovine rotavirus and coronavirus was 3.64% (4/110) and 0.91% (1/110), respectively. Diarrhea, feeding colostrum timing, and sex of the neonatal calves had statistically significant association with bovine rotavirus infection ( p < 0.05 ). All rotavirus-positive neonatal calves were identified in small scale dairy farms and in dairy farms that reported mortality though they lack statistically significant association. Only one coronavirus case was detected among the neonatal calves. The case was identified among small scale herds and in a herd with diarrheal cases. The sex of the coronavirus calf was female, diarrheic, and among 11-20 days old. Conclusion. The prevalence of rotavirus and coronavirus infections in neonatal calves was seldom in dairy farms of the study area. Rotavirus was more common than coronavirus, and further studies should be initiated on other (infectious and noninfectious) causes of neonatal calf diarrhea in the area.

Ethiopia's most important cash crop, coffee, generates the majority of the country's foreign revenue. However, to offer adequate yields requires a favorable atmosphere. Hence, the study focused on a perception of coffee producers to climate change and variability in Mana district, Jimma Zone, Southwestern Ethiopia. Essential data were collected utilizing questionnaires, focus group discussion, and key informant interviews, and 377 households were picked using simple random selection. Descriptive statistics such as mean, standard deviation, frequency, and percentage were used in data analysis, and also, the analysis of the household's perception of climate change was conducted using a Likert scale. The study found that 80.37 percent of sample households perceived climate change and variability, while 19.63 percent not perceived it. Different socioeconomic factors played their role in shaping the perception of the household to climate change and variability. The result of pairwise correction indicated that being a male head household, farming experience, educational status, agroecological setting, frequency of extension contacts, access to climate information positively correlated with perception of the household to climate change and variability. And the trend analysis showed that whereas the average temperature in the study area was increased by 0.038 °C/year, annual rainfall was decreased by 26.649 mm/year. As a result, in the research region, a coffee producer should adopt adaption methods and design and apply a long-term plan to manage climate change and vulnerability-related risk to keep the endurance of coffee production.

Tungiasis (sand flea disease) is a neglected tropical disease caused by penetration of female sand fleas, Tunga penetrans, into a person’s skin usually in their feet. The disease inflicts immense pain and suffering on millions of people, particularly children. The condition is most prevalent in Latin America, the Caribbean, and sub-Saharan Africa. Currently, there is no standard drug treatment for tungiasis. The available treatment options are fairly limited and unrealistic to use in endemic areas; as a result, in desperation, the affected people do more harm to themselves by extracting the fleas with non-sterile instruments, further exposing themselves to secondary bacterial infections and/or transmission of diseases such as hepatitis B virus, hepatitis C virus, or HIV. This highlights the urgent need for simpler, safer, and effective treatment options for tungiasis. Tea tree oil (TTO) has long been used as an antiseptic with extensive safety and efficacy data. The evidence on parasiticidal properties of TTO against ectoparasites such as head lice, mites, and fleas is also compelling. The purpose of this review is to discuss the current tungiasis treatment challenges in endemic settings and highlight the potential role of TTO in the treatment of tungiasis.

Haileslassie Tesfay,1 Girum Sebsibe,2 Tewodros Tesfaye2 1College of Medicine and Health Sciences, Debre Birhan University, Debre Birhan, Ethiopia; 2Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Tewodros TesfayeDepartment of Nursing, School of Nursing and Midwifery, Addis Ababa University, PO Box 4412, Addis Ababa, EthiopiaTel +251 913 69 80 81Email teddykera@gmail.comBackground: Early childhood developmental assessment refers to the continual process of observing, gathering, recording, and interpreting information to make developmental and instructional decisions and measure young children’s performance over time. Significant changes in the physical and neuropsychomotor developmental milestones take place in the first 2 years of life. Children younger than 3 years of age (36 months) who are at risk of having developmental delays may be eligible for early intervention treatment services. The study aimed to assess practice in early childhood developmental assessment and its determinants among health professionals working in public hospitals in Addis Ababa, Ethiopia.Methods: This facility-based descriptive cross-sectional study was conducted from September to April 2018, with a total sample size of 268 health professionals from six public hospitals in Addis Ababa, Ethiopia. The data were entered into EpiData software version 4.2, and analyzed by SPSS version 23 software for bivariate and multivariable logistic regression analysis. Significant associations were taken as p< 0.05 and the strength of associations was expressed using odds ratios.Results: The practice of early childhood developmental milestone assessment was found to be 27.8%. Being a general practitioner (AOR=23.826, 95% CI: 6.77– 83.9, p=0.000) or health officer (AOR=11.02, 95% CI: 2.1– 58.812, p=0.005), and work experience greater than 11 years (AOR=20.897, 95% CI: 1.5– 291.49, p=0.024) were significantly associated with good practice of early childhood developmental milestone assessment.Conclusion: Practice of early childhood developmental milestone assessment remains poor. Training and sharing experiences among different professions, and assigning professionals with the highest levels of work experience in the service could improve the practice levels.Keywords: early childhood, developmental milestone assessment, practice

This study was conducted on a total of 776 goats (part of Central highland goat breeds of Ethiopia), 306 from Boset district of Oromia region and 470 were from Minjar Shenkora district of Amhara region. A format developed by using food and agriculture organization discerption list was used for recording of morphological traits, bodyweight and linear body measurements. Both qualitative and quantitative traits were recorded from randomly sampled mature goats and the data were analyzed using SAS software. The goat type in the study area was characterized by a higher proportion of plain coat color patterns (62.5). Ingeneral, the majority (98.4%) of the studied goats were horned and characterized by backward orientation (67%) with a straight shape (49.3%). They presented a concave facial profile (73.8%), slop up toward the rump back profile (66.2%), no wattle (99.6%), no toggle (90.7%), no ruff (85.9%) and no beard (57.3%). The location had a significant effect on body weight and some other linear body measurements. Traits like body length, rump length, horn length, head length, head width and shin circumference were significantly higher in Boset district. In contrast, rump width and cannon bone length were significantly lower. The mean body weight of male goats in Boset and Minjar Shenkora district were 30.5±1.05 kg with a range of 16 to 47 and 27.5±0.56 with a range of 13 to 57, respectively. While for female counterpart mean body weights (kg) were 28.4±0.35 with a range of 17 to 45 for Boset and 27.5±0.33 with a range 15 to 57 for Minjar Shenkora district. Heart girth had the highest correlation with body weight in both sexes and shoulder width in Boset male goats. The wider variation in most quantitative measurement traits would open an opportunity for further improvement, conservation and utilization work.

BACKGROUND AND OBJECTIVES Viloxazine extended-release (viloxazine ER) capsules (QelbreeTM) is a novel nonstimulant recently approved as a treatment for attention-deficit/hyperactivity disorder in children and adolescents. Here, we determined whether the pharmacokinetics of viloxazine are impacted by consuming the capsule contents sprinkled on applesauce rather than an intact capsule, and the effect of a high-fat meal on the pharmacokinetics of viloxazine ER. METHODS This was a randomized, open-label, crossover, three-treatment, three-period study in healthy adults using orally administered single-dose viloxazine ER 200 mg capsules. Subjects consumed: (1) an intact capsule after a 10-h fast (control condition); (2) the capsule contents sprinkled on one tablespoon of applesauce; and (3) an intact capsule with a standard high-fat meal. Blood samples were collected for 48 h post-dosing. Relative bioavailability analyses were performed to assess the impact of each test condition against the control condition (intact capsule, fasting). The absence of an impact was indicated if the 90% confidence interval (CI) for the least-squares geometric mean ratio (LSGMR) of maximal concentration (Cmax), the area under the concentration-time curve from time 0 to the last measurable concentration time (AUClast), and the area under the concentration-time curve from time 0 to infinity (AUCinf) were within the predetermined no-difference limits of 80-125%. RESULTS Out of 27 enrolled subjects, 25 were included in the pharmacokinetic analysis. The LSGMR (90% CI) for viloxazine ER sprinkled vs. intact were 90.10% (83.35-97.40) for Cmax, 93.71% (89.09-98.57) for AUClast, and 95.37% (89.80-101.28) for AUCinf. The LSGMR (90% CI) for viloxazine ER consumed in the fed state vs. fasting state were 90.86% (84.05-98.21) for Cmax, 89.68% (85.26-94.33) for AUClast, and 92.35% (86.96-98.07) for AUCinf. The 90% CIs of the LSGMRs were within the predetermined no-difference limits of 80-125%. Viloxazine ER was well tolerated, with most adverse events reported as mild. CONCLUSIONS These data suggest that viloxazine ER can be consumed sprinkled on applesauce or as intact capsules with or without meals without significantly changing its pharmacokinetics.

To address self-employment with entrepreneurship, there are various forms of financial and non-financial motivations that influence entrepreneurial intentions and autonomy towards self-employment. In consideration of this, the study investigates the influence of entrepreneurial intention and autonomy on self-employment under different levels of technical and vocational educations and training institution’s support. To meet this aim, the study used both descriptive and explanatory research design and analyzed the data collected from 124 sample respondents using descriptive and hierarchical regression analysis. From this, the finding shows that the extent of entrepreneurial intention and autonomy were not at a good level, while they significantly influence self-employment. Similarly, human capital development improves the influence of entrepreneurial intentions on self-employment. Therefore, technical and vocational educations and training colleges should focus more on human capital development in improving self-employment. Moreover, future research should test the influence of specific variables such as technical and vocational educations and training institutions support flexibility and entrepreneurship training as determinants of self-employment.

Introduction Lifelong medical management is the main intervention to reduce diabetes-related morbidities and premature deaths; yet, social support can be a vital intervention to improve diabetics' health. Therefore, this study aimed to determine the magnitude, types, and role of social support in diabetes management in southern Ethiopia. Methods A multi-stage systematic sampling was applied to recruit 634 adult diabetics from the three-tiered healthcare system in the region. We proportionally distributed the sample size between randomly selected ten health-care facilities across the hierarchy. Pretested questionnaires and checklist; Epi-Info, and SPSS software used for data collection; entry, and analyses, respectively, and the statistical significance was determined at a P-value ≤0.05. Results A total of 240 females and 356 males completed the study, and the overall magnitude of the social support was 50.20% [95% CI: 46.19%, 54.21%], and it was categorized into non-material and material with 44.13% [95% CI: 40.14%, 48.12%] and 34.23% [95% CI: 30.42%, 38.04%] magnitudes, respectively, and social support was left to the patients' families and friends whereas formal institutions and the public sectors were rarely offering when the patients needed it. Though sex, educational level, and health-care hierarchy were not significantly associated with the social support, residence, some occupations, presence of diabetic family members, acute medical conditions, blood glucose level, compliance to medical follow-ups, treatment adherence, and taking anti-diabetic drugs a day before the current visit to health-care facility were all statistically significantly associated with social support. Conclusion One of every two adult diabetic patients in southern Ethiopia was receiving any social support, and social support for diabetic people reduces medical follow-ups absenteeism, improves treatment adherence, glycemic level controlling, and helps lifestyle modifications. Therefore, to keep diabetic people healthy and achieve diabetes management goals, the Ethiopian healthcare system, institutions, and concerned stakeholders should strengthen the social support for diabetic patients.

Shiferaw Letta,1 Fekadu Aga,2 Tesfaye Assebe Yadeta,1 Biftu Geda,3 Yadeta Dessie4 1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia; 4School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCorrespondence: Shiferaw LettaSchool of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box: 235, Harar, EthiopiaTel +251911771934Email shife1973@gmail.comBackground: All types of diabetes can damage the heart, blood vessels, eyes, kidneys, nerves and increase the overall risk of disability and premature death. Diabetes mellitus requires a range of self-care practices, scientifically recommended to control the glycemic level and maintain the patient’s health. However, perceived barriers that hinder patients from fully implementing these diabetes self-care practices and obstacles have not been thoroughly explored. Therefore, this study aimed to explore the barriers to diabetes patients’ self-care practices from the perspective of health care providers in two public hospitals in Harar City, Eastern Ethiopia.Methods: Researchers conducted an exploratory qualitative study among 26 health care providers working in two public hospitals from March to June 2021. The study participants were recruited from different disciplines working on diabetes care. Interviews were conducted in the Amharic language until the saturation point was reached. The interviews were tape-recorded, transcribed, and translated to English. Each transcript was read, re-read, and then exported to ATLAS.ti 7 software for coding. Field notes were used to supplement verbatim transcriptions. Initial codes were generated. The consistency between the two coders and their alignment with research questions were checked and applied to all subsequent transcripts after reached on consensus. The thematic analysis was employed in line with the primary set research question.Results: Researchers identified barriers to diabetes patients’ self-care practices such as system, health care providers, and patient-level. These barriers were categorized under three main themes: lack of organized diabetes care services, limited collaborative care practices, and perceived lack of knowledge on self-care practices. In addition, the lack of multidisciplinary team care, lack of training for health care providers on diabetes self-care practices, and availability of laboratory tests and diabetes medication were prominent barriers.Conclusion: Multi-level barriers to diabetes patients’ self-care practices such as system, health care providers, and patients were identified. Therefore, interventions targeting proper service integration, building providers’ and patients’ capacity on diabetes self-care practices, and ensuring the sustainability of laboratory tests and medication supplies are essential. These interventions need to be accomplished through multi-level stakeholders’ engagement and one-to-one or group interventions covering the multi-level challenges.Keywords: diabetes, self-care, barriers, health care providers, holistic care, Eastern Ethiopia

Background Patient satisfaction is a widely used indicator to measure quality of pharmacy services. Currently, a transformational pharmacy service called auditable pharmaceutical transactions and services is being implemented nationally in Ethiopia. However, there is a dearth of evidence regarding the national impact of this system on patient satisfaction. Objective To assess patient satisfaction in hospital pharmacies that have implemented auditable pharmaceutical transactions and services in Ethiopia. Method This is a national study conducted based on a cross-sectional study design. Data were collected using a structured questionnaire from September 5 to October 5, 2020. The collected data was analyzed using spreadsheet excel and Statistical Package for the Social Sciences (SPSS) version 23. The proportions, ratios, and percentages were used for presenting data. A binary logistic regression test was used to determine the association of patient satisfaction with dispensary infrastructure, medicines availability, scores of labeling, and scores of patient knowledge on dispensed medicines. A p value Result A total of 650 participants were included in this study for whom a total of 1422 medicines were prescribed which gives an average of 2.19 medicine per patient. The availability of the prescribed medicines in the pharmacies was 1061 (75%), and the affordability of medicines was 1.93 WD that indicates an unaffordable price. The average written medication labels score of 3.1 out of 8 points and the average patient knowledge score for correct usage of medicines was 4.5 out of 6 points. Overall, 585 (90%) of patients reported being satisfied with pharmacy services; the counseling skill of pharmacists 609 (93.7%), and dispensing area 607 (93.4%) cited the most. The only significantly associated factor for satisfaction was the infrastructure of the pharmacy. Conclusion Overall satisfaction of patients with the auditable pharmaceutical transactions and services implemented in hospital pharmacy services was generally high. The participants were most satisfied with the pharmacist counseling and dispensary area. The medication availability is moderate but the cost is unaffordable. Advanced infrastructures have resulted in a significant improvement in patient satisfaction.

Eskezyiaw Agedew,1 Belay Boda,2 Tesfaye Kanko,2 Wubshet Estifanos,3 Tamiru Shibiru4 1Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia; 2Department of Biomedical Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 3School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 4School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, EthiopiaCorrespondence: Belay Boda PO Box: 021 Tel +251 916 27 84 53Fax +251 46881-4264Email belaylove2002@gmail.comIntroduction: Chronic obstructive pulmonary disease (COPD) is a worldwide public health problem. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as a common, preventable and treatable disease characterized by progressive airflow limitation. Nowadays, COPD has become the third leading cause of death and fourth cause of mortality in the world.Objective: To assess chronic obstructive pulmonary disease and associated factors in Arba Minch – Health and Demographic Surveillance Site (AMU-HDSS) of Arba Minch University.Methods: A community-based cross-sectional study was conducted in AMU-HDSS among 615 individuals who were > 15 years of age. Study participants were selected randomly by the lottery method. Spirometer device was used to measure lung function. Binary logistic regression analysis was computed to assess the crude association between dependent and independent variables. Finally, variables which showed association in binary logistic regression analysis and have a P-value less than 0.3 were entered into multivariable logistic regression model to identify significant factors.Results: The prevalence of spirometry diagnosed COPD was 10.6%. Highland residence showed higher proportion of COPD case which accounts 63.8% compared to 36.2% in lowland residence. Study participants who were in advanced age > 41 years adjusted odd ratio (AOR) 3.65 (1.83, 7.28), living in highland area AOR 1.71 (1, 2.92), those who are elementary education level 2.45 (1.13, 5.28), who had no separate house for domestic animals AOR 2.84 (1.38, 5.85), having house which had no windows AOR 3.05 (5.79, 1.12) and living in traditional hut (tukulu), AOR 5.92 (1.19, 29.42) were significantly associated with chronic obstructive pulmonary disease in the study area.Conclusion and Recommendation: Chronic obstructive pulmonary disease was one of respiratory illnesses in people who live in highland and traditional house lacking windows for air circulation. Improving housing condition of traditional hut by constructing window, separating domestic animals house from humans and minimizing animal dung smoke exposure is necessary to reduce the respiratory illness.Keywords: spirometer, housing condition, air pollution, Arba Minch University

Lami Bayisa,1 Tesfaye Abera,1 Diriba Mulisa,1 Getu Mosisa,1 Alemnesh Mosisa,1 Tadesse Tolosa,2 Ebisa Turi,2 Bizuneh Wakuma,3 Eba Abdisa,1 Diriba Bayisa4 1Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia; 2Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia; 3Department of Pediatric Nursing, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia; 4Department of Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, EthiopiaCorrespondence: Lami BayisaDepartment of Nursing, Institutes of Health Sciences, Wollega University, P.O. Box: 395, Nekemte, EthiopiaTel +251 924318135Email lamisabayisa@gmail.comBackground: HIV continuum of care demands early ART initiation for all HIV-infected individuals. Early ART initiation reduces onward HIV transmission facilitating rapid viral suppression. Despite this, delayed ART use is a challenge among newly diagnosed HIV-positive individuals, and there is limited evidence on time to ART initiation among this group in Ethiopia. Thus, this study aimed to assess time to ART initiation and its predictors among newly diagnosed HIV-positive individuals in Nekemte town, Western Ethiopia.Methods: An institution-based retrospective follow-up study was conducted on 518 newly diagnosed HIV-positive people from September 5, 2016 to December 20, 2020 at Nekemte town, Western Ethiopia. Data were collected from ART intake forms, registration log books and patient charts. The collected data were entered into Epi Data version 3.1 and STATA version 14.0 was used for analysis. Survival probability was checked graphically by Kaplan–Meier curve and statistically by Log rank test. Both bivariable and multivariable Cox Proportional hazards regression models were conducted to identify the predictors of ART initiation. Hazard ratio with 95% CI and p-value of < 0.05 was used to declare a statistical significance.Results: By the end of the follow-up, 371 (71.6%) individuals had initiated ART with an overall incidence rate of 51.9 per 1000 [95% CI: 54.07– 66.32] person days; median time to ART initiation was 4 [IQR: 1– 9] days. Being female (AHR = 1.33, 95% CI: 1.06– 1.67), urban dwellers (AHR = 2.02, 95% CI: 1.37– 2.97), having baseline OIs (AHR = 1.62, 95% CI: 1.60– 4.30); being tested via VCT (AHR = 1.33, 95% CI: 1.02– 1.74); linked from OPD (AHR = 0.64, 95% CI: 0.47– 0.85); disclosing HIV sero-status (AHR = 2.07, 95% CI: 1.17– 3.68); and college and above education level (AHR = 1.43, 95% CI: 1.00– 2.0) were identified as significant predictors of early initiation of ART.Conclusion: The proportion and incidence of ART initiation was high; a short median time to ART initiation was revealed in this study. Strictly screening OIs, encouraging HIV sero-status disclosure and voluntary HIV testing are recommended to increase early ART initiation.Keywords: ART initiation, time to ART initiation, newly diagnosed HIV positive, Ethiopia

Background Older adult patients are prone to potentially inappropriate medication use (PIMU); its use has been associated with multiple adverse consequences. As a result, it is crucial to determine the magnitude and factors associated with PIMU. The present study was mainly aimed to determine and assess the magnitude and predictors of potentially inappropriate medication use in older adult patients on follow-up at the chronic care clinic of Jimma medical center. Methods A retrospective cross-sectional study was conducted involving 219 patients aged 65 years and above on treatment follow-up. Data was collected using a checklist. The 2019 updated American Geriatric Society (AGS) Beers Criteria® and Screening Tool of Older People’s Potentially Inappropriate Prescriptions criteria and Screening Tool to Alert Doctors to Right Treatment (STOPP/START) criteria (version 2) were employed to assess PIMU. SPSS IBM (v22) was used for data entry and analysis. Categorical variables were described using frequency and percentage, whereas continuous variables were described using mean with standard deviation (SD) or median with interquartile range (IQR). Logistic regression was conducted to identify predictors of PIMU. Results The average number of medications prescribed per patient was 4.0 (IQR = 2.0). At least one PIMU was identified in 182 (83.1%) and 99 (45.2%) patients, based on Beers and STOPP criteria, respectively. Additionally, potential prescription omission (PPO) was observed in 24 (10.9%) patients. The risk of Beers PIMU was increased with age [AOR = 1.21, p 0.001], hypertension [AOR = 4.17, p 0.001], and polypharmacy [AOR = 14.10, p 0.001], while a decrease in the risk was noted in patients with a diagnosis of ischemic stroke [AOR = 0.133, p = 0.01] and asthma [AOR = 0.03, p 0.001]. Using STOPP criteria, hypertension [AOR = 2.10, p = 0.04], diabetes mellitus [AOR = 2.26, p = 0.04], ischemic heart disease [AOR = 2.84, p = 0.04], peripheral neuropathy [AOR = 10.61, p 0.001], and polypharmacy [AOR = 6.10, p 0.001] significantly increased the risk of PIMU. Conclusions Regardless of the screening tool used to assess, the present study revealed PIMU in the large proportion of the participants. Multiple medication use and certain disease condition had increased the probability of PIMU. Hence, it is imperative to use screening tools for reviewing medications prescribed in older adult patients to ensure safety of medication therapy.

Background: Peritonitis is one of the commonest causes of acute abdomen in Ethiopia. One of the causes of high morbidity and mortality is persistent intraabdominal infection. The two essential approaches for managing post-op collection are laparotomy on-demand and planned Relaparotomy. Despite multiple studies, both have comparative mortality. This study aimed to identify clinical variables that are predictive of persistent intraabdominal infection. Methods: A retrospective study was conducted on patients who were operated on from Sept 2018 to April 2020 at two affiliated referral hospitals of AAU, college of Medicine; Yekatit 12 hospital Medical College and Minilik II referral Hospital. All of the patients were cases of secondary peritonitis. Clinical progress of the patients from admission to discharge/death was documented. Multiple preoperative and intraoperative variables were analyzed to develop the predictive clinical model. Results: Out of 172 laparotomy cases for secondary peritonitis, 40 (23.3%) required relaparotomy for postop collection. From Patients who developed postop collection, 45% of them were diagnosed after pus/Gi content leaked through the surgical wound. The mortality rate of patients who develop postop collection and undergone relaparotomy was 27.5 % and 4.5% for those without postop collection. Logistic regression identified 4 variables as having significant predictive value: Duration of illness more than 5 days, Systolic BP 1000 ml, and small bowel as a source of contamination. Overall prediction successes of the above model is 88.4% (sensitivity 53.3%, specificity 96.8%). Conclusion: Management of persistent intra-abdominal infection is challenging. We have identified 4 clinical variables that predict persistent intraabdominal infection requiring relaparotomy. These sets of variables can be a milestone for future validation study before being inserted in today to day clinical practice. Keywords: Relaparotomy, predictors, laparotomy, secondary peritonitis, intra-abdominal infection

Sorghum anthracnose caused by the fungal pathogen Colletotrichum sublineolum, is one of the most economically important diseases of sorghum globally and in Ethiopia. Breeding for resistance to this highly variable pathogen requires identification of new sources of resistance. Here we describe the identification of new sources of anthracnose resistance from a field-based screening of 225 landrace genotypes of sorghum collected from different parts of Ethiopia. Field trials were conducted at Assosa and Bako Agricultural research centres under natural infection to evaluate anthracnose resistance. Analysis of variance revealed significant differences in mean square due to environment, genotype and genotype by environment interactions (P ≤ 0.01) for leaf anthracnose disease relative AUDPC. Most genotypes from Western Ethiopia, a region known for high rain fall and high anthracnose disease incidence, displayed resistance reactions. Disease severity index and AUDPC showed negative correlation with agronomic, yield and yield related traits. Cluster analysis based on disease parameters suggested that accessions from neighbouring regions shared strong similarity. Seven genotypes at Bako and five genotypes at Assosa showed moderate resistance. Anthracnose resistance and better yield performance across locations were observed for three genotypes. These materials will be important for genetic studies to determine genetic control of resistance and for resistance breeding.

Bauhinia thonningii is a woody leguminous tree species, which is endowed with enormous soil improvement, medicinal, nutritional, and socio-ecological benefits in African. The current study was carried out to systematically review and document findings on the multiple benefits of B. thonningii and thereby identify gaps and opportunities for further comprehensive studies. A systematic and manual search was conducted to retrieve relevant articles published from 1974 to June 2021. Electronic databases of PubMed (Medline), Google Scholar, and grey literature were employed to access the studies. Accordingly, 100 articles and 2 thesis papers were finally included in this study. The study shows B. thonningii tree species improve soil fertility and its abundant litter accumulated from the leaves of B. thonningii trees contributed to increased organic carbon and total nitrogen content. The plant parts are used in several traditional medicine to treat different human and animal ailments. The pods and seeds of the plant contained a lot of important nutrients and nutritional value, beneficial to human as well as animal health. The plant plays a key role in biomass production and carbon sequestration potential. Owing to its multiple benefits, there is an urgent need to facilitate the scaling-up of the use of the tree by using various approaches. The findings will serve as a useful reference for further in depth investigations on the multifunctional uses of the plant across different ecozone as well as supporting the scale up of the benefits of the species.

This study aims to assess hand hygiene compliance and associated factors among healthcare providers in Dessie referral hospital (Ethiopia) using the gold standard WHO's observational checklist and self-administered questionnaire. Hand hygiene practices of 230 healthcare providers from ten hospital wards were observed over 24 hours period. The required numbers of sample were proportionally allocated among the different professions and wards. The overall observed hand hygiene compliance was only 17.6%. Hand hygiene training , availability of functional sink , knowledge about hand hygiene , attitude towards hand hygiene , availability of water and soap , and availability of alcohol-based hand rub were positively associated with hand hygiene compliance. As lower levels of compliance were observed for indications that have potential risk for patients, healthcare providers need to follow the WHO's multimodal hand hygiene improvement strategies. This study also indicated the important prerequisites that could help improve hand hygiene.

Background. Giant hydronephrosis is a rare urologic problem defined as a collection of more than one liter of urine in the collecting system. The radiologic appearance may mimic benign cystic disease of the kidney. We report a case of giant hydronephrosis in a 32-year-old female who presented with progressive abdominal swelling of two-year duration, caused by ureteropelvic junction obstruction with more than nine liters of urine in the collecting system. Conclusion. Giant hydronephrosis is a rare differential diagnosis for cystic intra-abdominal mass in adults with progressively increasing abdominal swelling. CT and MRI are important in confirming the diagnosis by localizing the origin of the swelling. Management depends on the underlying cause and appearance of the diseased kidney.

BACKGROUND: Despite the inadequate filling of prescriptions among chronic care patients has been a problem, little is known about the intervention effect on it. OBJECTIVE: The aim of this systematic review and meta-analysis (SRMA) was to investigate the effectiveness of various public health interventions on primary and secondary medication adherence among T2DM patients. METHODS: Searching was done from the major databases; Cochrane Library, Medline/PubMed, EBSCOhost, and SCOPUS. A hand search was made to find grey works of literature. Articles focused on interventions to enhance primary and secondary medication among type 2 diabetes mellitus patients were included. After screening and checking eligibility, the methodological quality was assessed. Secondary medication adherence was synthesized descriptively due to measurement and definition variations across studies. Finally, a meta-analysis was made using the fixed effects model for primary medication adherence. RESULTS: 3992 studies were screened for both primary and secondary medication adherences. Among these, 24 studies were included in the analysis for primary (5) and secondary (19) medication adherence. Pooled relative medication redemption difference was RD = 8% (95% CI: 6–11%) among the intervention groups. Age, intervention, provider setting, and IDF region were determinant factors of primary medication adherence. About two-thirds of the studies revealed that interventions were effective in improving secondary medication adherence. CONCLUSION: Both primary and secondary medications were enhanced by a variety of public health interventions for patients worldwide. However, there is a scarcity of studies on primary medication adherence globally, and in resource-limited settings for the type of adherences. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-021-00878-0.

Global change exposes forest ecosystems to many risks including novel climatic conditions, increased frequency of climatic extremes and sudden emergence and spread of pests and pathogens. At the same time, forest landscape restoration has regained global attention as an integral strategy for climate change mitigation. Owing to unpredictable future risks and the need for new forests that provide multiple ecosystem services, mixed-species forests have been advocated for this purpose. However, the successful establishment of mixed forests requires intrinsic knowledge of biodiversity's role for forest ecosystem functioning. In this respect, a better understanding of tree-tree interactions and how they contribute to observed positive tree species richness effects on key ecosystem functions is critical. Here, we review the current knowledge of the underlying mechanisms of tree-tree interactions and argue that positive net biodiversity effects at the community scale may emerge from the dominance of positive over negative interactions at the local neighbourhood scale. In a second step, we demonstrate how tree-tree interactions and the immediate tree neighbourhood's role can be systematically assessed in a tree diversity experiment. The expected results will improve predictions about the effects of tree interactions on ecosystem functioning based on general principles. We argue that this knowledge is urgently required to guide the design of tree species mixtures for the successful establishment of newly planted forests.

Kasiye Shiferaw,1 Bezatu Mengistie,2 Tesfaye Gobena,3 Merga Dheresa,1 Assefa Seme4 1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 4School of Public Health, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Kasiye Shiferaw Tel +251256662517Email sifkas.gem2@gmail.comPurpose: This study aimed to identify the extent of antenatal care content received and associated factors among Ethiopian women.Methods: A nationally representative Performance Monitoring for Action 2020 Ethiopian data were used. A multistage cluster sampling design was used to select 2855 pregnant or recently postpartum women nested within 217 enumeration areas. Female resident enumerators collected the data using a semi-structured questionnaire. Researchers dichotomized the number of ANC content received greater than or equal to 75 percentiles as adequate. Otherwise, it was considered inadequate. A multilevel Poisson regression was fitted. The result was reported using an incidence rate ratio with a 95% confidence interval and a p-value less than 0.05 was considered for statistical significance.Results: The study revealed more than a quarter of pregnant women received adequate ANC content (27.8%; 95% CI: 23.8%, 32.2%). Multivariable analysis revealed urban residence (IRR = 1.09, 95% CI: 1.01, 1.21), attending secondary and above formal education (IRR = 1.08, 95% CI: 1.01, 1.16), maternal age 20– 24 years (IRR = 1.10, 95% CI: 1.02, 1.19), and partner’s encouragement to attend clinic for antenatal care (IRR = 1.14, 95% CI: 1.05, 1.24) was significantly associated with receiving higher numbers of antenatal care content.Conclusion: The proportion of women who received adequate antenatal care content in Ethiopia was low. Despite Ethiopia’s effort to improve maternal health services utilization, disparities among regions and between rural and urban exist. This study highlights the importance of ensuring high received antenatal care content, which is crucial for reducing pregnancy-related morbidity and mortality. This implies prompt intersectoral collaboration to promote female education, target older aged women, and rural resident women, encourage partner involvements during the antenatal care process, minimize regional variation, and strengthen the implementation of received ANC content policies and programs with the active participation of the stakeholders are priority issues.Keywords: received, ANC contents, associated factors, Ethiopia

Introduction Availability and accessibility of a safe COVID-19 vaccine do not necessarily guarantee an effective means to mitigate the pandemic. However, the fragile hero’s or health care worker's attitude toward the vaccine is of paramount importance to promote its acceptance. So, the current review aims to provide the latest assessment of healthcare workers’ attitudes toward the COVID-19 vaccination and its contributing factor worldwide. Methods Peer-reviewed surveys in English indexed via an electronic database in Google Scholar, Science Direct and PubMed were systematically searched. The review was carried out per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-2009) and registered on PROSPERO (CRD42021265534). Results Originally 8039 articles were searched from three databases PubMed, Science direct, and Google scholar. Finally, 24 studies met the inclusion criteria and made the root for the estimates of the attitude of COVID -19 vaccinations. In about two-thirds of the studies, respondents showed a positive attitude (≥50%) toward COVID-19 vaccination. However, in about one-quarter of the studies, a negative attitude (

Introduction: The triple burden of COVID-19, human immune virus (HIV), and TB co infection is one of the contemporary challenges to this globe. People living with chronic medical diseases such as HIV and TB are more likely to experience poor outcomes from COVID-19. This study aimed to report survival from triple co-infection with PTB, HIV, and COVID-19 in Wollega University referral hospital (WURH), western Ethiopia. Case Presentation: A 55-year-old male known HIV patient on HAART for the last 3 years presented to WURH on May 26, 2021, with chief complaints of shortness of breath of 5 days' duration associated with productive cough, history of high-grade fever, and severe headache. He had produced a lot of bloody sputum one month prior to the current complaints. On 1st day of his presentation, a Gene Expert test was done from sputum, and he was positive for pulmonary TB. On the same day, a nasopharyngeal sample for COVID-19 using polymerase chain reaction (PCR) was positive. On his 2nd day of admission, he was transferred to the COVID-19 treatment center with the diagnosis of severe COVID-19, PTB, and WHO stage-3 RVI. During his stay in the hospital, he was provided with oxygen via a nasal cannula. Intensive phase anti-TB treatment was initiated on the 3rd day of admission. HAART was continued with the same regimen he was taking prior to his presentation. On June 6, 2021, the patient was recovered and discharged from the hospital after 10 days of hospital stay. Conclusion: This case report suggests, after 10 days of admission with triple infections, there is a good clinical prognosis and survival from COVID-19. On admission, further diagnosis and investigations of TB co-infection should be performed for all patients admitted with COVID-19 due to their similar and non-specific clinical manifestations.

Background Food policies and environment (availability, accessibility, affordability, marketing) in and around educational institutes can influence food choices and behaviours of children and adolescents. Methods Cross-sectional, mixed-methods study was implemented in schools (n = 9; Private = 6, Public = 3) and colleges (n = 4) from Delhi and National Capital Region (India). The data was collected from students of schools (n = 253) and colleges (n = 57), parents of school students (n = 190), teachers (n = 12, schools = 9, colleges = 3) and canteen operators of Private schools and colleges (n = 10; schools = 6, and colleges = 4). The primary and secondary data was collected to: 1) identify the strengths and weaknesses of the existing guidelines and directives (desk review); 2) examine food environment, existing policies and its implementation (structured observations, in-depth interviews, surveys, focus group discussions), and; 3) assess food choices, behaviours of students (focus group discussions). The thematic analysis was used for qualitative data and descriptive analysis for quantitative data. Results The available food and beverage options, in and around the participating educational institutes were either high in fat, salt and sugar (HFSS), despite government and educational institute guidelines on restricting the availability and accessibility of HFSS foods. The healthy food and beverage options were expensive compared to HFSS foods both inside and outside educational institutes. In total, 37 vendors (Private = 27; Public:10) were observed outside schools at dispersal and twelve at lunchtime. Around colleges, vendors (n = 14) were seen throughout the day. Students from all Private schools (n = 6) and colleges (n = 2) were exposed to food and beverage advertisements either HFSS (Private schools = 1–3 and colleges = 0–2 advertisements), whereas no advertisements were observed around Public schools. Conclusion It is imperative to implement food policies to improve the food environment in and around educational institutes to ensure the availability of healthy foods to establish and sustain healthy eating behaviours among students. Thus, the study findings emphasise stringent implementation, regular monitoring and surveillance of recently introduced Food Safety and Standards (Safe food and balanced diets for children in school) Regulation 2020, ensuring its compliance through effective enforcement strategies.

Tagel Tesfaye,1 Endrias Markos Woldesemayat,2 Nana Chea,2 Demelash Wachamo3 1Department of Public Health, Adare General Hospital, Hawassa, Sidama Regional State, Ethiopia; 2School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Sidama Regional State, Ethiopia; 3Department of Public Health, Hawassa College of Health Sciences, Hawassa, Sidama Regional State, EthiopiaCorrespondence: Demelash WachamoDepartment of Public Health, Hawassa College of Health Sciences, Hawassa, Sidama Regional State, EthiopiaTel +251 91 686 6654Email demmenew1@gmail.comBackground: Persons with disabilities experience significant barriers to accessing health care. These barriers may be more serious in countries such as Ethiopia. In this study, we aimed to assess the prevalence of accessibility and associated factors among physically disabled people visiting physical disability associations in Hawassa.Methods: A cross-sectional study was conducted among 345 randomly selected physically disabled people who visited disability associations in Hawassa. Data were collected from February 1 to 28, 2020 through face-to-face interview using a semi-structured questionnaire. Data analysis was done by SPSS version 23. Statistically significant test was declared using statistical cut-off point of P-value < 0.05.Results: Accessibility to healthcare services among respondents was 83 (25.4%). About three-quarters of these respondents (74.6%) experienced at least one access barrier to healthcare services; 61.5% experienced physical barriers, 62.7% reported barriers related to medical equipment and 59.3% had communication barriers. Male participants (AOR = 3.19, 95% CI: 1.70, 6.99), married individuals (AOR = 2.95, 95% CI: 1.59, 5.49), people whose costs for healthcare services was covered by NGOs (AOR = 3.23, 95% CI: 1.39, 7.51) and participants with no experience of discrimination when accessing healthcare services (AOR = 5.84, 95% CI: 3, 11, 10.95) had more access to healthcare services.Conclusion: Accessibility to healthcare services among people with disabilities was poor in the study. It is related with various factors. Therefore, it is important to strengthen inter-sectoral collaboration, promote community health insurance and strengthen the economic capacity of persons with physical disabilities in order to overcome barriers.Keywords: physical disability, healthcare service, access, barriers

Abebaye Aragaw Leminie,1 Tesfaye Tolessa Dugul,1 Eyasu Makonnen Eshetu,2 Daniel Seyifu Melka3 1Department of Physiology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia; 2Department of Pharmacology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia; 3Department of Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, EthiopiaCorrespondence: Abebaye Aragaw Leminie Email abebaye.aragaw@aau.edu.etBackground: The prevalence of chewing Catha edulis Forsk and the use of ascorbic acid is increasing from time to time. Their subchronic effects on hematological indices are not well examined. The present study was aimed to investigate their subchronic effects on hematological indices in rats.Materials and Methods: A total of 36 adult (7– 8 weeks) wild-type rats weighing between 213 and 229g were used in this study. They received Catha edulis Forsk extract (Ce) (100 milligrams/kilogram, 200 milligram/kilogram and 300 milligram/kilogram b.w), Catha edulis Forsk juice (2.5 mL/kg), ascorbic acid (AA 200 milligram/kilogram), and 2% tween 80 in distilled water (T80W- v/v) for twelve weeks. Hematological indices were measured with Sysmex KX-21. Data were analyzed by SPSS version 21.0 and Microsoft Excel.Results: Neutrocytes (p < 0.01), lymphocytes (p < 0.05), plateletcrit (p < 0.05), average size of platelets (p < 0.05), platelet size variability (p < 0.01), platelet–large cell ratio (p < 0.05) and neutrocytes/lymphocytes ratio (p < 0.001) were significantly greater, while hemoglobin concentration per red blood cell (p < 0.05) and hemoglobin concentration per volume of red blood cells were significantly reduced (p < 0.05) in rats received khat. The red cell distribution width (p < 0.05), platelet size variability (p < 0.05) and platelet–large cell ratio (p < 0.01) were significantly greater in rats received ascorbic acid.Conclusion: Crude Catha edulis Forsk extract and juice changed some hematological indices and increased platelet activities. The platelet activity was also increased by ascorbic acid. The mechanisms for these changes need to be investigated.Keywords: Catha edulis Forsk, ascorbic acid, hematological indices

Acinetobacter species, particularly Acinetobacter baumannii, is the first pathogen on the critical priority list of pathogens for novel antibiotics to become a “red-alert” human pathogen. Acinetobacter baumannii is an emerging global antibiotic-resistant gram-negative bacteria that most typically causes biofilm-associated infections such as ventilator-associated pneumonia and catheter-related infection, both of which are resistant to antibiotic therapy. A. baumannii’s capacity to develop antibiotic resistance mechanisms allows the organism to thrive in hospital settings, facilitating the global spread of multidrug-resistant strains. Although Acinetobacter infections are quickly expanding throughout hospital environments around the world, the highest concentration of infections occurs in intensive care units (ICUs). Biofilms are populations of bacteria on biotic or abiotic surfaces that are encased in the extracellular matrix and play a crucial role in pathogenesis, making treatment options more difficult. Even though a variety of biological and environmental elements are involved in the production of A. baumannii biofilms, glucose is the most important component. Biofilm-mediated A. baumannii infections are the most common type of A. baumannii infection associated with medical equipment, and they are extremely difficult to treat. As a result, health care workers (HCWs) should focus on infection prevention and safety actions to avoid A. baumannii biofilm-related infections caused by medical devices, and they should be very selective when using treatments in combination with anti-biofilms. Therefore, this review discusses biofilm formation in A. baumannii, its role in disease pathogenesis, and its antimicrobial resistance mechanism.

Background: Formaldehyde (FA) is a sensitizing agent that can produce an effective immune system response upon initial exposure. FA that can be used in many industries, medical and anatomical facilities, mainly cadaver-based gross anatomy laboratories, represent a risk to occupational health of professionals and students. The majority of FA exposures occur through inhalation, dermal, and eye contact. FA-induced effects are attributed to site-specific and dosedependent health impairments in many organs and organ systems. Much progress has been reported on FA-induced health impairments in respiratory tract, but a comprehensive study in different organ systems and the reverse effects of some novel antioxidants is still lacking. This review explores the cytotoxic effects of FA and its role as key signaling molecule, site specific and or dose dependent effects of FA in nasal cavity, carcinogenic effects of FA exposure in nasopharynx, effects of FA in lung macrophage functions and development of pulmonary fibrosis, dose dependent reproductive and genetic effects of FA, neurotoxic effects of FA and potential risk of FA in some beauty salons and cosmetic products. In addition, this study shows the counteracting beneficial role of melatonin, Nigella sativa, rose oils, caffeic acid phenethyl ester (CAPE), vitamin E, and proanthocyanidins (PAs) against FA induced tissue damage.Methods: A comprehensive literature search highlighting the health impairments of FA and counteracting beneficial effects of promising antioxidants was conducted using PubMed, Google Scholar, and Medline Cochrane, to assemble relevant publications from open access international journals published only in English.Results: The search generated 411 articles of which 70 full research articles fulfilled the inclusion criteria and included in the review. The results of this study confirmed relentless toxic effects of FA exposure on various organs of human and other animals. Multiple findings also stated the efficacy of promising antioxidants against FA-induced tissue damage in animal models.Conclusion: Occupational exposure to FA is most likely due to inattention towards its side effects and lack of appropriate air filtering equipment or unmonitored concentration of FA in the working air. Therefore, re-evaluating the concentration of FA, proper ventilation, and assessment of working practices is highly recommended. Proper monitoring is also needed to improve compliance and protection of FA-based reproductive complications in females. Despite complete prevention is not viable, exposed personnel must be aware of FA-induced health effects and require assessing risks and acquiring practical measures in their working environment.

Introduction Lack of regional- and local-based cut-off points of lipid profile and/or anthropometric measurements remains one of the challenges in prevention, early detection and control of non-communicable diseases. This study aimed to validate anthropometric-based screening of lipid profiles to develop locally appropriate optimal cut-off points for metabolic syndrome screening. Methods A community-based cross-sectional study was conducted among randomly selected 977 adults in Jimma Town, Ethiopia. Data were collected using structured questionnaire, anthropometric and biochemical measurements. Data were analyzed using SPSS windows version 21 and Kappa statistic was used to validate the agreement between anthropometric measurement and lipid profile. A p-value of

Introduction Early detection of the unrecognized diabetes mellitus (DM) and its risk factors in the community is crucial to minimizing the burden of DM and associated complications. Hence, this study aimed to assess unrecognized DM and its relationship with behavioral characteristics, physical characteristics, and lipid profile among adults in Jimma Town, Southwest Ethiopia. Methods A community-based cross-sectional study was conducted on 915 adults in Jimma Town from June 17 to July 27, 2019. Physical measurements, lipid profile, and blood sugar levels were measured. The collected data were entered and analyzed using Epi Data 3.1 and SPSS version 21, respectively. Multivariable logistic regression was fitted to assess predictors of unrecognized DM where adjusted odds ratio (AOR) with its corresponding 95% confidence interval (CI) was used to assess the strength of association at P-value ≤05. Results The prevalence of unrecognized DM and impaired glucose metabolism (pre-diabetes) were 3.1% (95% CI; 2.0-4.4) and 14.8% (95% CI; 12.5-17.2), respectively. The risk of unrecognized DM was higher among male participants (AOR = 2.94, 95% CI: 1.19, 7.29), age group of 35 years and above (AOR = 3.45, 95% CI: 1.16, 10.27), and high waist circumference (AOR = 4.21, 95% CI: 1.72, 10.33). On the other hand, participants who perform sufficient physical activity (AOR = 0.14, 95% CI: 0.03, 0.58) had low risk of undetected DM. Conclusion The prevalence of unrecognized diabetes mellitus was relatively high. Male sex, advanced age, physical inactivity, and high waist circumference were found to be predictors of unrecognized DM. Thus, awareness needs to be created among the community to practice regular physical activity and maintaining normal body weight. Additionally, screening of DM should be promoted for early detection, prevention, and treatment.

Computing path queries such as the shortest path in public transport networks is challenging because the path costs between nodes change over time. A reachability query from a node at a given start time on such a network retrieves all points of interest (POIs) that are reachable within a given cost budget. Reachability queries are essential building blocks in many applications, for example, group recommendations, ranking spatial queries, or geomarketing. We propose an efficient solution for reachability queries in public transport networks. Currently, there are two options to solve reachability queries. (1) Execute a modified version of Dijkstra’s algorithm that supports time-dependent edge traversal costs; this solution is slow since it must expand edge by edge and does not use an index. (2) Issue a separate path query for each single POI, i.e., a single reachability query requires answering many path queries. None of these solutions scales to large networks with many POIs. We propose a novel and lightweight reachability index. The key idea is to partition the network into cells. Then, in contrast to other approaches, we expand the network cell by cell. Empirical evaluations on synthetic and real-world networks confirm the efficiency and the effectiveness of our index-based reachability query solution.

Purpose Harmful alcohol use among University students is a problem throughout the world. However, little is known about alcohol use disorders among JFD university students in Ethiopia. Therefore, this study aimed to assess the prevalence and associated factors of alcohol use disorder (AUD) among Jimma University undergraduate students. Methods Institution-based cross-sectional study was conducted among Jimma university students. Data were collected from 741 sampled students who were selected through a multi-stage stratified sampling technique. Alcohol Use Disorder Identification Test (AUDIT), Oslo 3 items social support scale (OSS-3), and Kessler-6 (K6) tools were used to assess alcohol use disorders, social support, and psychological distress, respectively. Data were analyzed through SPSS version 20.0. Bivariate and multivariate logistic regression analyses were conducted and adjusted odds ratio (AOR) at a 95% confidence interval (CI) was used to determine the independently associated factors of AUD. Results The overall prevalence of AUD among Jimma University undergraduate students was 26.5%. There was a positive and independent association between AUDs and being single AOR= 1.98, 95% CI [1.21, 3.22], having a history of mental illness AOR= 1.98, 95% CI [1.04, 3.75], having a history of suicidal attempt AOR= 3.63, 95% CI [1.18, 11.11], smoking cigarette AOR= 5.04, 95% CI [2.02, 12.57], having peer pressure to drink alcohol AOR= 2.72, 95% CI [1.76, 4.19] and presence of mental distress AOR= 2.81, 95% CI [1.83, 4.32]. Conclusion The findings of this study showed that the prevalence of AUD was high in the sampled undergraduate students of Jimma University. AUD was positively associated with mental, substance, and behavioral risk factors. Therefore, concerted actions needed to emplace to increase the student's awareness of the effect of harmful alcohol use. Moreover, it is recommended that further studies need to be conducted to develop strategies for evidence-based interventions.

One of the constraints to controlling foot-and-mouth disease (FMD) in East Africa is the incomplete knowledge of the specific FMD virus (FMDV) strains circulating and the way in which these viruses move across countries in the region. This retrospective study focuses on Ethiopia, which has one of the largest FMD-susceptible livestock populations in Africa. Analyses of FMDV positive samples collected between 2008 and 2019 demonstrate that serotypes O (n = 175), A (n = 51) and SAT 2 (n = 33) were present in the country. Phylogenetic analysis of the VP1 sequences for these viruses showed that there were at least seven different FMD viral clades circulating during this period: O/EA-3, O/EA-4, A/AFRICA/G-I, A/AFRICA/G-IV, A/AFRICA/G-VII, SAT2/VII and SAT2/XIII. Although these results only represent a snapshot and might not reflect all FMDV lineages that were present, they highlight the importance of serotype O, as well as the complexity and co-existence of FMDV serotypes in Ethiopia and surrounding countries. These sequence data also support the idea that there are two FMDV ecosystems existing in East Africa. Data from retrospective studies, such as these presented here, will be beneficial for vaccine selection and vaccination campaigns to control FMDV within Ethiopia. ispartof: TRANSBOUNDARY AND EMERGING DISEASES vol:67 issue:6 pages:2983-2992 ispartof: location:Germany status: published

Background COVID-19 pandemic has a devastating impact on the economies and health care system of sub-Saharan Africa. Healthcare workers (HWs), the main actors of the health system, are at higher risk because of their occupation. Serology-based estimates of SARS-CoV-2 infection among HWs represent a measure of HWs’ exposure to the virus and could be used as a guide to the prevalence of SARS-CoV-2 in the community and valuable in combating COVID-19. This information is currently lacking in Ethiopia and other African countries. This study aimed to develop an in-house antibody testing assay, assess the prevalence of SARS-CoV-2 antibodies among Ethiopian high-risk frontline HWs. Methods We developed and validated an in-house Enzyme-Linked Immunosorbent Assay (ELISA) for specific detection of anti-SARS-CoV-2 receptor binding domain immunoglobin G (IgG) antibodies. We then used this assay to assess the seroprevalence among HWs in five public hospitals located in different geographic regions of Ethiopia. From consenting HWs, blood samples were collected between December 2020 and February 2021, the period between the two peaks of COVID-19 in Ethiopia. Socio-demographic and clinical data were collected using questionnaire-based interviews. Descriptive statistics and bivariate and multivariate logistic regression were used to determine the overall and post-stratified seroprevalence and the association between seropositivity and potential risk factors. Results Our successfully developed in-house assay sensitivity was 100% in serum samples collected 2- weeks after the first onset of symptoms whereas its specificity in pre-COVID-19 pandemic sera was 97.7%. Using this assay, we analyzed a total of 1997 sera collected from HWs. Of 1997 HWs who provided a blood sample, and demographic and clinical data, 51.7% were females, 74.0% had no symptoms compatible with COVID-19, and 29.0% had a history of contact with suspected or confirmed patients with SARS-CoV-2 infection. The overall seroprevalence was 39.6%. The lowest (24.5%) and the highest (48.0%) seroprevalence rates were found in Hiwot Fana Specialized Hospital in Harar and ALERT Hospital in Addis Ababa, respectively. Of the 821 seropositive HWs, 224(27.3%) of them had a history of symptoms consistent with COVID-19 while 436 (> 53%) of them had no contact with COVID-19 cases as well as no history of COVID-19 like symptoms. A history of close contact with suspected/confirmed COVID-19 cases is associated with seropositivity (Adjusted Odds Ratio (AOR) = 1.4, 95% CI 1.1–1.8; p = 0.015). Conclusion High SARS-CoV-2 seroprevalence levels were observed in the five Ethiopian hospitals. These findings highlight the significant burden of asymptomatic infection in Ethiopia and may reflect the scale of transmission in the general population.

Background Anemia is one of the most common blood abnormalities in people with HIV. The incidence of anemia ranges from 10% in people who have no HIV symptoms to 92% among individuals who have advanced AIDS. Anemia which is also one of the major challenges among HIV patients can lead to impaired physical functioning, psychological distress, poor quality of life, accelerated disease progression, and shorter life expectancy. There are different reports that show a large number of patients with both anemia and HIV/AIDS in Ethiopia. However, the burden of anemia among those HIV/AIDS patients receiving ART is not fully understood in Gedeo zone health institutions. Hence, this study is designed to assess the prevalence of anemia and associated factors among adult HIV/AIDS clients receiving ART at Gedeo zone health institutions, SNNPR, Ethiopia. Methods An institution-based cross-sectional study was conducted in Gedeo zone health institutions from November 21 2017 to January 30, 2018. The systematic random sampling technique was used to recruit the study participants. The hematocrit level was used to determine anemic status. Data were entered into EPI info version 7 and transferred to STATA version 12.0 for analysis. In order to identify factors associated with anemia, a multivariable logistic regression analysis was employed. Result A total of 422 patients were included with a mean age of 33.85 (SD = ±9. 12) years. The prevalence of anemia was 34.8% (95% CI 30.1-39.8), while about 7.4%, 14.3%, and 13.1% of the patients had severe, moderate, and mild anemia, respectively. The mean hemoglobin was 14.6 (SD=±10. 8), (95% CI 13.6_15.8). INH/Isoniazid prophylaxis (OR =1.8 [95% CI: 1.1, 2.9]) and bedridden functional status (OR =5.48 [95% CI: 1.25, 23.8]) were determinants of anemia in this study. Conclusion In this study, a large number of pateients had anemia (34.8%) with the majority of them having a moderate form. Functional status and using INH prophylaxis were determinant factors of anemia.

Background and objective Ecological studies have suggested an association between exposure to particulate matter ≤2.5 μm (PM2.5 ) and coronavirus disease 2019 (COVID-19) severity. However, these findings are yet to be validated in individual-level studies. We aimed to determine the association of long-term PM2.5 exposure with hospitalization among individual patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We estimated the 10-year (2009-2018) PM2.5 exposure at the residential zip code of COVID-19 patients diagnosed at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020. Logistic regression was used to determine the odds ratio (OR) and 95% CI for COVID-19 hospitalizations associated with PM2.5 , adjusting for socioeconomic characteristics and comorbidities. Results Among the 14,783 COVID-19 patients included in our study, 13.6% were hospitalized; the geometric mean (SD) PM2.5 was 10.48 (1.12) μg/m3 . In adjusted analysis, 1 μg/m3 increase in 10-year annual average PM2.5 was associated with 18% higher hospitalization (OR: 1.18, 95% CI: 1.11-1.26). Likewise, 1 μg/m3 increase in PM2.5 estimated for the year 2018 was associated with 14% higher hospitalization (OR: 1.14, 95% CI: 1.08-1.21). Conclusion Long-term PM2.5 exposure is associated with increased hospitalization in COVID-19. Therefore, more stringent COVID-19 prevention measures may be needed in areas with higher PM2.5 exposure to reduce the disease morbidity and healthcare burden.

What is known and objective: Self-report questionnaires are used to measure medication adherence, often times both clinically and for research purposes. Despite the presence of several published tools, some may have prohibitive licensure and fee requirements, which researchers should be aware of prior to using them. This paper presents a summary of selected self-report measures, which have been developed and validated in various health conditions and can be used free of cost. Comment: Our review identified self-report tools that are valid to measure medication adherence in different chronic health conditions. Most of these tools measure both intentional and unintentional non-adherence and have shown good correlation with relevant clinical outcomes. What is new and conclusion: Given the potential copyright risks associated with using some of the self-report measures of adherence, an improved awareness and understanding of the available self-report questionnaires will better facilitate the decision by researchers to select appropriate tools relevant to their studies.