Search

Background: Trachoma is the leading infectious cause of blindness. However, little is known about the behavioural and environmental determinants of transmission of the causative organism, Chlamydia trachomatis. We conducted formative research in a trachoma hyper-endemic area of Ethiopia to explore the behaviours which are likely to contribute to trachoma transmission and map their determinants. Methodology/Principal findings: Data on water use, hygiene, defecation, and sleeping arrangements were collected from five communities during the dry and rainy seasons in 2016. Data collection involved direct observation in households (n = 20), interviews with caregivers (n = 20) and focus group discussions (n = 11). Although several behaviours that likely contribute to trachoma transmission were identified, no single behaviour stood out as the dominant contributor. Hygiene practices reflected high levels of poverty and water scarcity. Face washing and soap use varied within and between households, and were associated with other factors such as school attendance. Children’s faces were rarely wiped to remove nasal or ocular discharge, which was not perceived to be socially undesirable. Bathing and laundry were performed infrequently due to the amount of time and water required. Open defecation was a normative practice, particularly for young children. Latrines, when present, were poorly constructed, maintained and used. Young children and parents slept closely together and shared bedding that was infrequently washed. Conclusions/Significance: Existing norms and enabling factors in this context favour the development of interventions to improve facial cleanliness as more feasible than those that reduce unsafe faeces disposal. Interventions to increase the frequency of bathing and laundry may also be infeasible unless water availability within the home is improved. [ABSTRACT FROM AUTHOR]

Worldwide, the ecto-parasitic mite Varroa destructor has been assigned as an important driver of honey bee (Apis mellifera) colony losses. Unlike the subspecies of European origin, the honey bees in some African countries such as Uganda and Ethiopia may not be as threatened or suffer less from mite-infestations. However, only little is known about the factors or traits that enable them to co-exist with the mite without beekeepers’ intervention. Hence, this study was designed to investigate these factors or traits that limit the Varroa mite population in Ethiopian honey bees (Apis mellifera simensis). The study was conducted in the primary honey producing region of Ethiopia, i.e. Tigray. Mite infestation levels were shown to be lower in traditional hives (when compared to framed hives) and when colonies were started up from swarm catching (when compared to colony splitting). However, the influence of the comb cell size on mite infestation was not observed. With respect to the bee biology, the hygienic behavior was shown to be high (pin-test: 92.2% removal in 24 hours) and was negatively correlated with phoretic mite counts (Pearson; r = -0.79; P < 0.01) and mite infestation levels in brood (Pearson; r = -0.46; P < 0.001). Efforts to estimate the Varroa mite reproductive capacity were seriously hampered by an extremely low brood infestation level. From the 133 founder mites found (in 6727 capped brood cells) only 18.80% were capable of producing a reproductive progeny. Failure to produce adult male progeny was unexpectedly high (79.70%). We have suggested a few adaptations to the test protocols allowing to estimate the protective traits of honey bee colonies under very low Varroa pressure. Apart from that, this study demonstrates that the honey bees from Ethiopia are suitable targets to further decipher the genetic predisposition of resistance against V. destructor. It is still unclear to what extent simensis differs from the more common scutellata subspecies. [ABSTRACT FROM AUTHOR]

Background: Road Traffic Accidents have become an enormous global public health problem killing approximately 1.25 million people and injuring 20 to 50 million others yearly. It is the 10th leading cause of death universally and the number one cause of mortality of the young population between the ages of 5 and 29. Only few studies have been conducted on the severity of road traffic injuries in Ethiopia hence the need for the study. Objective: To assess injury severity level and associated factors among road traffic accident victims. Methods: A cross-sectional study of patients involved in road traffic accident and attended Tirunesh Beijing hospital, Addis Ababa, Ethiopia. Victims were consecutively recruited until sample size (164) attained during the study period. Data collectors administered a structured questionnaire. The collected data was then entered and cleaned using Epi info and exported to IBM SPSS for statistical analysis. Independent factors associated with injury severity were assessed using bivariate and multivariate logistic regression. Results: A total of 164 road traffic injury victims were included to the study. Prevalence of severe injury accounted for 36.6% of cases. “can read and write” educational status OR 35.194(95% CI; 3.325–372.539), sustaining multiple injury OR 18.400(95% CI; 5.402–62.671), sustaining multiple injury type OR 6.955(95% CI; 1.716–28.185) and being transported by ambulance from the scene of accident OR 13.800(95% CI; 1.481–128.635) were the explanatory variables found to have a statistically significant association with severe injury. Conclusion: This study showed road traffic accident is predominantly affecting the economically active, male young population. Not a single victim received pre-hospital care, majority were extracted by bystanders and most used commercial vehicle to be transported to a health institution reflecting the need for improvements in pre-hospital emergency services and socio-economic related infrastructures. [ABSTRACT FROM AUTHOR]

Background: Falls among older adults is a common precipitating factor for unintentional injuries and represent a major health problem associated with increased morbidity, mortality, and health care cost in low-and-middle-income countries. The burden of fall in this population is well established in high-income countries and scant attention is given to this precipitating factor in low-and-middle-income countries, including Ethiopia. Therefore, this study aimed to estimate the prevalence and factors associated with fall among community-dwelling older adults in Ethiopia. Methods: A community-based cross-sectional study was conducted among community-dwelling older adults of Gondar. Multi-stage random sampling technique was used across administrative areas. Six hundred and five households were selected proportionally using systematic random sampling technique. Physical measurement and face to face interview method were employed using a structured questionnaire for data collection. Data were analyzed descriptively and through uni- and multivariate logistic regression model. Results: One hundred and seventy (n = 170, 28.4%; 95% CI 24.7–32.1) community-dwelling older adults reported having experienced fall in the past 12 months. Sex (OR = 1.91, 95% CI: 1.24–2.95), low educational status (OR = 2.37, 95% CI: 1.19–4.74), uncomfortable home environment (OR = 2.02, 95% CI: 1.34, 3.04), having diagnosed medical condition (OR = 4.659, 95% CI: 1.20–18.02), and use of medication (OR = 5.57, 95% CI: 1.19–26.21) were significantly associated risk factors of self-reported fall in the past 12 months. Most outdoor falls are associated with females and participants aged below 66 years. Conclusion: In conclusion, more than 1/4th of the community-dwelling older adults experienced at least one episode of fall and about 60% of them reported recurrent falls. Identifying risk group and risk factors that could be modified so as to prevent falls in older adults deserves attention. Outdoor falls are usually attributable to modifiable environmental aspects and improvements in outdoor environment needed. [ABSTRACT FROM AUTHOR]

Background: In response to a physician shortage in Ethiopia, the number of medical students admitted to public universities was rapidly increased through a “flooding” policy. Objectives: To assess medical student perceptions on the impact of the “flooding” policy on medical education and e-learning initiatives, as well as plans for future emigration. Design: A cross-sectional survey of medical students at AAU was implemented in 2014. Attitude and practice items were assessed using a Likert scale. Logistic regression analysis was performed to identify characteristics associated with an interest in future emigration. Results: 673 (99.6%) of 676 students approached completed the survey, representing 39.5% of all 1705 medical students enrolled at AAU in 2014. Most students felt the “flooding” policy had a negative impact on their medical education and >90% felt there was not adequate infrastructure to support the increased student body. E-learning activities to accommodate increased class size included distribution of electronic tablets, but at the time of the survey only 34.8% of students still had a working tablet and 82.3% reported problems with internet connectivity. Most preclinical students (85.1%) who had attended live-streamed lectures preferred traditional classroom lectures. Half of the students (49.5%) intended to practice medicine in Ethiopia. Independent risk factors for planning to emigrate included age <21 years (aOR = 1.30, 95% CI 1.04, 1.97); having applied to medical school for reasons other than “wanting to be a physician” (aOR = 1.55, 95% CI 1.14, 2.20), and not believing that “flooding” policy would increase the number of physicians working in Ethiopia (aOR = 1.87, 95% CI 1.33, 2.58). Conclusions: The “flooding” policy lead to significant educational challenges that were not fully alleviated by e-learning initiatives. Concomitant increases in resources for infrastructure development and faculty expansion are needed to maintain quality medical education. Additional research is needed on factors that influence medical graduates decision to emigrate. [ABSTRACT FROM AUTHOR]

Background: Prevention and control of hypertension has not been given due attention though previous studies indicated that hypertension is growing public health problem. Objective: This study aimed to determine the prevalence of hypertension and associated factors in Bona district, southern Ethiopia. Methods: A community based cross-sectional study was conducted on 1952 participants aged ≥25 years in Bona District, southern Ethiopia. Data were collected from consented participants recruited using multistage sampling technique. Data were entered, checked for quality and analyzed by SPSS for Windows version 20.0. Since the outcome variables were ordered categorical, we used multinomial logistic regression model to identify associated factors. Among the independent variables included in the model no multicolinearity was observed. The level of significance was set at P value ≤ 0.05. Results: The observed prevalence of hypertension (21.8%) was remarkable in rural setting. Out of hypertensive participants, 195 (45.9%) were newly diagnosed. About one third of the participants (31.4%) had central obesity measured by waist-to-height ratio ≥0.50. Being male, age advancement, high BMI (≥25.0 kg/m2) and central obesity (waist-to-height ratio ≥0.50) were positively associated with both systolic and diastolic hypertension. Systolic hypertension was negatively associated with high family income. The likely hood of developing diastolic hypertension increased in participants with family history of hypertension. Conclusion: The overall prevalence of hypertension, 21.8%, is alarmingly high that it can be said that hypertension is becoming a silent epidemic in Ethiopia. Nationwide survey is needed to get the clear magnitude of hypertension so that early detection and management strategies can be enforced. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to measure the prevalence and associated factors of Intimate Partner Violence (IPV) among women living with and without HIV in Wolaita Zone, Southern Ethiopia. Methods: A comparative cross-sectional study design was used to interview the 816 women between 18–49 years of age (408 = HIV positive, 408 = HIV negative). Using a multistage sampling technique, participants were recruited from nine health facilities based on probability proportional to the number of clients. After data entry (EpiData version 4.4.2.0) the data were exported to STATA/SE 15 software. Binary and multivariable logistic regression analysis were undertaken and the odds ratio (OR) and 95% confidence interval (CI) are presented. Results: The lifetime prevalence of IPV among all women was 59.7%, [95% CI: 56.31%-63.05%]. IPV was slightly higher among women living with HIV, 250(61.3%), than those who were HIV negative, 238(58.1%). Lifetime prevalence of emotional violence 413(50.6%), physical violence 349(42.8%), sexual violence 219(26.8%), and controlling behaviours by husbands/partners 489(59.9%) were reported. Associations were found between IPV and controlling behaviour of husband/partner [AOR = 8.13; 95% CI: 4.93–13.42],income [AOR = 3.97; 95% CI:1.81–8.72], bride price payment [AOR = 3.46; 95% CI:1.74–6.87], women’s decision to refuse sex [AOR = 2.99; 95% CI: 1.39–6.41],age group of women [AOR = 2.86; 95% CI:1.67–4.90], partner’s family choosing wife [AOR = 2.83; 95% CI:1.70–4.69], alcohol consumption by partner [AOR = 2.36;95% CI:1.36–4.10], number of sexual partners [AOR = 2.35; 95% CI:1.36–4.09], and if partner ever physically fought with another man [AOR = 1.83; 95% CI:1.05–3.19]. Conclusions: There is a high prevalence of IPV against women both living with and without HIV. Policy priorities should therefore involve males in programs of gender-based violence prevention in order to change their violent behaviour, and interventions are required to improve the economic status of women. Both sexes should be advised to have a single partner and marriage arrangements should be by mutual consent rather than being made by parents. [ABSTRACT FROM AUTHOR]

Background: Despite the universal iodization of salt in Ethiopia, iodine deficiency disorder remains a major public health problem and continued to affect a large segment of the population. It is thus essential to assess factors contributing to the unacceptably high endemic goiter rate in the country and avail evidence for further additional interventions. In line with this, we examined the association of dietary pattern and iodine deficiency among school-age children in Ethiopia. Method: We conducted a school-based cross-sectional study among 767 children aged 6 to 12 in southwest Ethiopia. We collected socio-demographic and other important health related information using a pre-tested structured questionnaire through the interview. Dietary pattern of children was measured using modified Hellen Keller’s food frequency questionnaire. We measured iodine deficiency using urinary iodine concentration level and total goiter rate, according to the World Health Organization threshold criteria. We used a multivariate linear regression model to identify dietary and sociodemographic factors that affect urinary iodine level among children. Result: Out of the 767 children included in the study, 12% and 4% of children have grade 1 and grade 2 goiter respectively, making the total goiter rate 16%. While the prevalence of iodine deficiency based on urinary iodine concentration is 58.8% of which 13.7% had severe, 18.6% had moderate and 26.5% had mild form. The proportion of children who consumed godere/taro root/, banana, corn, Abyssinian cabbage, and potato, respectively at daily basis 57.8%, 53.1%, 37.9%, and 31.2%, respectively. Age (β = -0.7, 95%CI = -1.1, -0.4), sex (β = -22.3, 95%CI = -33.8, -10.8), consumption of taro root (β = -27.4, 95%CI = -22.9, -31.8), cabbage (β = -11.7, 95%CI = -5.7, -17.6), Abyssinian cabbage (β = 12.4, 95%CI = 6.7, 18.2), and banana (β = 5.6, 95%CI = 0.01, 11.2) significantly associated with urinary iodine level. Conclusion: Iodine deficiency remains an important public health problem in southwest Ethiopia. Over-consumption of goitrogenic foods and under-consumption of iodine-rich foods were prevalent and associated with lower urinary iodine level. Therefore, dietary counseling apart from universal salt iodization is recommended. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB), a bacterial infectious disease, continues to be a public health concern in many developing countries. However, lack of data concerning the public health burden and potential risk factors for the disease hampers control programs in target areas. Therefore, the aims of present study were to determine the prevalence of TB and genetic diversity of M. tuberculosis isolates from individuals visiting health facilities in South Gondar Zone, northwest Ethiopia. Methods: A cross-sectonal study was conducted between March 2015 and April 2017. Bacteriological examination, region of difference (RD) 9 based polymerase chain reaction (PCR) and spoligotyping were used. Results: The overall prevalence of all smear positive TB was 6.3% (186/2953). Extra pulmonary TB (EPTB) was clinically characterized in about 62.4% (116/186) TB-positive cases. Some demographic characteristics, such as patients' origin (districts where patients were recruited) [patients’ origin (chi-square (χ2) value; 62.8,p<0.001) were found to be significantly associated risk factors for the occurrence of TB in the study area. All the mycobacterial isolates were found to be M. tuberculosis. Among the 35 different spoligotype patterns identified, 22 patterns were shared types.The three dominantly identified families were T, CAS and Manu, each consisting of 46.9%, 24.0% and 10.4% of the isolates, respectively. Conclusion: The present study revealed that TB continues to be a public health problem in South Gondar Zone which suggests a need of implementing effective disease control strategies. [ABSTRACT FROM AUTHOR]

Background: Recent trends in sexual behavior, demonstrated in most countries, continue to indicate that more people are adopting safer sexual behaviors. However, there are signs of an increase in risky sexual behaviors in several countries. This study aimed to assess sexual behaviors and associated factors among youths in Nekemte town, East Wollega, Ethiopia in 2017. Methods: A community-based cross sectional study was conducted using a self-administered questionnaire. Then, the collected data were analysed using logistic regressions with 95% confidence interval (CI). Besides, the results of data analysis were `presented using appropriate descriptive measures and tables. Findings: Almost half of the respondents, 144(48.6%) had practiced sexual intercourse. Factors associated with ever had sexual intercourse include: being in age group 20-24(AOR = 2.322, 95% CI (1.258, 4.284)), having pocket money (AOR = 1.938, 95% CI (1.057, 3.556)), not attending school (AOR = 2.539, 95% CI (1.182, 5.456)), watching pornography (AOR = 4.314, 95% CI (2.265, 8.216)) and drinking alcohol (AOR = 7.725, 95% CI (3.077, 19.393)). Conclusion: High proportions of youths were practicing sexual intercourse. Targeting those identified associated factors in future intervention plan would improve the sexual behaviors of youths. [ABSTRACT FROM AUTHOR]

Introduction: Some studies in developing countries have shown that infant mortality is highly associated with maternal education, implying that maternal education might play an important role in the reduction of infant mortality. However, other research has shown that lower levels of maternal education does not have any significant contribution to infant survival. In this systematic review, we focus on the effect of different levels of maternal education on infant mortality in Ethiopia. Methods: MEDLINE, EMBASE, CINAHL, Scopus, and Maternity and Infant Care databases were searched between November 15, 2017 and February 20, 2018. All articles published until February 20, 2018 were included in the study. The data extraction was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA 2009) guidelines. An I2 test was used to assess heterogeneity and a funnel plot was used to check publication bias. Findings: We retrieved 441 records after removing duplications. During screening, 31 articles were fully accessed for data extraction. Finally, five articles were included for analysis. The overall pooled estimate indicated that attending primary education was associated with a 28% reduction in the odds of infant mortality compared to those infants born to mothers who were illiterate, OR: 0.72 (95% CI = 0.66, 0.78). Another pooled estimate indicated that attending secondary education and above was associated with a 45% reduction in the odds of infant mortality compared to those infants born to mothers who were illiterate, OR: 0.55 (95% CI = 0.47, 0.64). Conclusion: From this study, understanding the long-term impact of maternal education may contribute to reduce infant mortality. Therefore, policy makers should give more attention in promoting the role of women through removing institutional and cultural barriers, which hinder women from access to education in order to reduce infant mortality in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence is a thoughtful public health concern and human rights violation towards pregnant women for it has a significant negative health effect on the life of both the mother and her fetus. However, there is a scanty of information about the extent of intimate partner violence during pregnancy in Ethiopia, particularly in the study area. Therefore, the current study was conducted to determine the prevalence of intimate partner violence among pregnant women attending antenatal care and identify associated factors that cause it. Methods: An institution based cross-sectional study was conducted on 409 pregnant women who were attending antenatal care service in Debre Markos town from March 17, 2018 –April 28, 2018. Systematic random sampling technique was used to select study participants. A pre-tested structured questionnaire was used to collect the data. Bivariable and Multivariable logistic regression models were done. Adjusted odds ratio with 95% confidence interval was used to identify factors associated with intimate partner violence during pregnancy. Results: The prevalence of intimate partner violence during current pregnancy was found to be 41.1% (95% confidence interval (CI): 36.0–46.0). Of this, the prevalence of psychological, physical, and sexual violence was 29.1%, 21%, 19.8% respectively. Lower educational status of partners (AOR = 3.26, 95%CI: 1.45–7.36), rural residency (AOR = 4.04, 95%CI: 1.17–13.93), frequent alcohol abuse by partner (AOR = 4.79, 95% CI: 2.08–11.04), early initiation of antenatal care (AOR = 0.44, 95% CI: 0.24–0.81), the age of women between 17–26 years (Adjusted odds ratio (AOR) = 0.21, 95%CI: 0.09–0.49),choice of partner by the women only (AOR = 3.26,95% CI:1.24–8.57) were statistically significant factors associated with intimate partner violence towards pregnant women. Conclusions: In this study, the prevalence of intimate partner violence during pregnancy is found to be high. As a result, interventions that would address the above mentioned factors need to be implemented. [ABSTRACT FROM AUTHOR]

Despite the significant reductions seen in under-5 child mortality in Ethiopia over the last two decades, more than 10,000 children still die each year in Tigray Region alone, of whom 75% die from preventable diseases. Using an equity lens, this study aimed to investigate the social determinants of child health in one particularly vulnerable district as a means of informing the health policy decision-making process. An exploratory qualitative study design was adopted, combining focus group discussions and qualitative interviews. Seven Focus Group Discussions with mothers of young children, and 21 qualitative interviews with health workers were conducted in Wolkayit district in May-June 2015. Data were subjected to thematic analysis. Mothers’ knowledge regarding the major causes of child mortality appeared to be good, and they also knew about and trusted the available child health interventions. However, utilization and practice of these interventions was limited by a range of issues, including cultural factors, financial shortages, limited female autonomy on financial resources, seasonal mobility, and inaccessible or unaffordable health services. Our findings pointed to the importance of a multi-sectoral strategy to improve child health equity and reduce under-5 mortality in Wolkayit. Recommendations include further decentralizing child health services to local-level Health Posts, and increasing the number of Health Facilities based on local topography and living conditions. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence is a major challenges faced by women especially in developing world. Its consequences range from personal health problems up to countrywide loss of productivity and poverty. There is limited empirical evidence documenting intimate partner violence and underlying reasons in Ethiopia. Therefore, the aim of this study was to assess the magnitude of intimate partner violence and associated factors in Ethiopia. Methods: We analyzed the 2016 Ethiopian demographic and health survey data. About 2,750 women aged 15–49 years were included in the survey. Intimate partner violence was measured in three dimensions: physical, emotional and sexual violence. Multiple logistic regression was conducted to identify independent predictors. Variables with p-value less than 0.05 were considered as significantly associated with dimensions of violence. All analysis were adjusted for clusters and sample weights. Results: Overall 32.5% of Ethiopian women experienced at least one type of intimate partner violence. Physical and emotional violence were each experienced by 22.5% of the women, while 9.6% of the study participants encountered sexual violence. The age difference between a woman and her intimate partner has a positive effect on emotional and sexual violence while the opposite is true for physical violence. Moreover, physical violence was significantly associated with place of residence, and husband education. Both emotional and sexual violence were predicted by wealth of the household and husband’s employment status. In addition to these, lower educational status of the partner affects emotional violence positively. Conclusion: Substantial proportion of women in Ethiopia continue to suffer from intimate partner violence. Physical and emotional violence were much more common than sexual violence. In the light of determinants, we have reported in here, we recommend empowering women in all realm of life by improving their socio-economic status with focus to their educational and economic status. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) against women is a major public health concern in low income countries. Violence against pregnant women has adverse effects on maternal and newborn outcomes. This study aimed to assess the prevalence and associated factors of intimate partner violence in Southeast Ethiopia pregnant women. Methods: Institutional based cross-sectional study was conducted on pregnant women who were attending antenatal care (ANC) in Bale Zone health institution during study period. Face to face interviews were conducted using a pre-tested structured questionnaire. Data related to socio-demographic characteristic, pregnancy and reproductive history, intimate partner behavior and IPV encountered during recent pregnancy was gathered for this study. Descriptive analysis and logistic regression were used for the data analysis. Odds ratio with 95% CI was computed to determine the presence and strength of associated factors with IPV. Results: A total of 612 pregnant women participated in the study. Of these, 361 (59.0%) pregnant women faced at least one type of IPV during the recent pregnancy. Physical violence (20.3%), sexual violence (36.3%), psychological/emotional violence (33.0), controlling behavior violence (30.4%) and economic violence (27.0) were the type of IPV encountered by participants. An intimate partners who were drank alcohol [AOR = 2.9; 95% CI: (1.5–5.4)], partners who were chewed Khat [AOR = 1.7; 95% CI: (1.1–2.6)], partners who were smoked cigarette [AOR = 2.6; 95% CI: (1.4–4.9)], partners who had aggressive behavior [AOR = 2.8; 95% CI: (1.7–4.6)], having partner age ≥30 year old [AOR = 1.8; 95% CI: (1.2–2.9)], unwanted pregnancy [AOR = 3.3; 95% CI: (1.9–5.5)] and history of adverse pregnancy outcome [AOR = 2.1; 95% CI: (1.2–3.6)] that were the factors that significantly associated with IPV of the pregnant women. Conclusion: The prevalence of IPV during pregnancy was high among the study participants. Intimate partners’ use of substance, intimate partners’ aggressive behavior, older intimate partners, unwanted pregnancy and history of adverse birth outcome were identified as associated factors for IPV. IPV needs to be considered during ANC service and integrated into the sexual and reproductive health education. Community-based interventions should be advocated as a way of health promotion. Counseling, awareness creation, service provision and program design on IPV is mandatory to minimize the victim. [ABSTRACT FROM AUTHOR]

Background: Goiter is a major public health problem in Ethiopia. Even though there were studies done on goiter in Ethiopia, there was little evidence in the eastern part of the country. Therefore, the aim of this study was to assess the prevalence of goiter and its associated factors among school-age children in Anchar district of Eastern Ethiopia. Methods: A school based cross-sectional study was conducted from February 13 to 30, 2017. Multistage sampling method was used to select 418 children aged 6–12 years. Data were collected using a questionnaire. Children were examined for the presence or absence of goiter based on the criteria of the World Health Organization (WHO). Salt samples were tested using a rapid test kit. Data were entered to EpiData version 3.1 and exported to SPSS version 22.0 for analysis. Bivariate and multivariate logistic regression models were fitted; Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were computed. Level of significance was determined at p-value less than 0.05. Results: The total goiter prevalence rate was 51.8% (CI: 46.9%, 56.8%). Father’s education (AOR = 1.87, CI: 1.06, 3.30), type of salt used (AOR = 2.09, CI: 1.13, 3.88), iodine level of salt (AOR = 2.77, CI: 1.11, 6.89), frequency of milk consumption (AOR = 3.65, CI: 1.63, 8.20), frequency of cabbage consumption (AOR = 7.74, CI: 4.48, 13.39), eating status of eggs (AOR = 3.16, CI: 1.54, 6.50), and eating status of dark green vegetables/fruits (AOR = 2.14, CI: 1.17, 3.93) were factors associated with goiter among school-age children. Conclusions: The total goiter prevalence rate was very high. Therefore, the health and education sectors of the study area should work hand in hand to improve the awareness of the community about goiter, iodized salt and iodine rich foods. [ABSTRACT FROM AUTHOR]

Background: Under-nutrition in early childhood has harmful impacts on human capital formation in children, with implications for educational, adult health, and labor market outcomes. We investigate the association of linear growth and weight gain in mid-childhood with years of schooling, the Peabody Picture Vocabulary Test score, and math test score during the adolescent age of 14–15 years. Methods: Data were derived from the Young Lives study conducted in four low- and middle-income countries (Ethiopia, India, Peru, and Vietnam). The data had detailed information on the children anthropometry and characteristics of the child, household, and community. Multivariate regression analysis, adjusted for the confounding variables, was used to investigate the association between mid-childhood health, measured by conditional linear growth and relative weight gain, and human capital outcomes in adolescent age. Results: After controlling for several confounders, one cm increase in conditional linear growth increased years of schooling by 0.034 years and the Peabody Picture Vocabulary Test score and math test score by 0.474 and 0.083 points respectively. Relative weight gain was negatively associated with years of schooling and math test score. There is no evidence of heterogeneous effects by rural, gender, and household wealth. In the quantile regression analyses, the association between conditional linear growth and outcomes is stronger at the lower level of years of schooling and the Peabody Picture Vocabulary Test score. Conclusion: Our study highlights that mid-childhood nutritional intervention targeted for students at the lower level of education distribution can accelerate the rate of human capital accumulation in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

School health and nutrition (SHN) programmes are recognized as a significant contributor to both health and education sector goals. The school system offers an ideal platform from which to deliver basic health interventions that target the most common health conditions affecting school-age children (SAC) in low-income countries, leading to improved participation and learning outcomes. However, governments require evidence to cost, design, and implement these programmes. In Ethiopia, prevalent health conditions affecting SAC's education participation and learning outcomes include infection with soil-transmitted helminths (STHs), hunger, and malnutrition. In recognition of the multiple issues affecting the health and education of SAC, the government has taken a proactive approach, coordinating an integrated SHN programme designed to be implemented in partnership and monitored and financed through a single, integrated mechanism. The programme, known as the Enhanced School Health Initiative (ESHI), integrates three complimentary health interventions: deworming; school feeding; and provision of a water, sanitation, and hygiene (WASH) package in schools, which in delivery aim to maximize the benefits of each of the individual components. Operational research surrounding the ESHI programme includes both qualitative and quantitative analyses. Here, we present an overview of the ESHI programme and its genesis. We also introduce three additional supporting papers that provide in-depth analyses of key findings, including the baseline situational analysis, the costs, and community perceptions of the programme. The findings from ESHI provide initial evidence to develop an understanding of the related costs and synergies of integrating multiple health interventions onto a single platform. The work has translated into strengthened institutional capacity and improved cross-sectoral coordination. The government is now committed to supporting 25 million school children in Ethiopia through SHN. The ESHI model serves as a reference point for other countries looking to scale up targeted SHN interventions. [ABSTRACT FROM AUTHOR]

Introduction: Unintended pregnancy is a pregnancy which is not wanted and/or not planed at the time of conception. It has a major consequence on mothers’ and newborns’ health and its prevalence remains a major health problem in Ethiopia. This study was aimed to assess the prevalence and determinants of unintended pregnancy among pregnant women attending antenatal clinics of Addis Zemen hospital. Methods: An institutional-based cross-sectional study was employed in Addis Zemen hospital from April 01 to May 30, 2018. The sampled 398 pregnant mothers were selected by systematic random sampling. The data were collected using a-pretested structured questionnaire via face to face interview and the collected data were analyzed by using SPSS Version-20. The data were summarized with frequency and cross-tabulation. Both binary and multiple logistic regressions were used in order to identify predictor variables using odds ratio at 95% confidence interval. Results: All of 398 mothers answered the questionnaire making the response rate 100%. The prevalence of unintended pregnancy was 26.1% (CI;22.1, 30.4). Women who were multigravid (AOR; 4.7: CI; 2.3, 6.8), women who were multipara (AOR; 2.8: CI; 2.6, 9.7), and women who were from rural (AOR; 2.6: CI; 1.5, 4.6) were more likely experienced unintended pregnancy than their counterparts. Women who were Muslim (AOR; 0.79: CI; 0.6, 0.90) and women who attended secondary education (AOR; 0.58: CI; 0.42, 0.78) were less likely experienced unintended pregnancy. Conclusion and recommendation: The prevalence of unintended pregnancy is high in the study area. Educational status, parity, gravity, residence, and religion were the most important predictor variables of unintended pregnancy. Reducing the prevalence of unintended pregnancy especially in the rural area is recommended. [ABSTRACT FROM AUTHOR]

Maternal and child feeding behaviors are often rooted in family and sociocultural context, making these an important point of inquiry for improving nutrition and health over the life course. The present study explored the practice of fasting during religious periods in relation to eating patterns of pregnant and lactating women and young children in four regions of Ethiopia, a nation which has experienced rapid economic growth and marked improvement in health and nutrition outcomes over the last two decades. Qualitative data collection and analysis at community level illustrated conflicting areas of understanding and practice related to diets of children and pregnant and lactating women during fasting times, potentially leading to gaps in nutrition. Community participants described different understandings of fasting requirements for these vulnerable populations and associated social norms and doxa, not always in accordance with religious texts or published guidance. Useful behavior change strategies may be developed through these results to address the potential barriers to appropriate feeding patterns for pregnant and lactating women and young children in Ethiopia. This will include continuing to work with communities and religious leaders to clarify that religious doctrine promotes improved nutrition outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of copious information regarding contraceptive use benefits and the factors that influence the uptake of the services, there is little evidence revealing the lived experiences of rural women. Thus, this study was conducted with the purpose of exploring the lived experiences of women regarding contraceptive use and related benefits towards women’s empowerment. Methods: Interpretative phenomenological qualitative methodology was employed to explore the lived experiences of women. Data were collected through focus group discussions and in-depth individual interviews and analyzed using an interpretive phenomenological framework including phases of data immersion, transcribing, coding, theme development and phenomenological interpretation through hermeneutic circle. Result: The reported lived experiences of rural women revealed that their livelihoods greatly improved in different ways after they began to use contraceptives. The benefits included securing more time, energy and social engagements. Contraceptive use helped women postpone unwanted pregnancies and child births and engage in various income generation activities that not only boosted family incomes but also created opportunity to mobilize the resources for different expenses without waiting for the handouts from their husbands. The women’s experiences also indicated that contraceptive use improved the educational status of their daughters and they experienced improved self-image, better social standing and improved family relations. The experiences further illustrated that contraceptive use was not only emancipatory and transformative, but also created peace and stability in their lives. Conclusion: The study concludes that contraceptive use, which is part of a woman’s life experience, created remarkable opportunities and achievements. One of these was that women were able to control their bodies, reproduction and fertility which resulted in a higher degree of empowerment. The control of reproduction and fertility has liberated them from worries and entrapment of unplanned and unwanted pregnancies. Moreover, contraceptive use led to wider opportunities in the community, by improving their status and building a sense of empowerment. Creating awareness around the benefits of contraceptive use has the potential to improve community and national development. Based on the result, the study recommends that systems should be established to capitalize on the lessons learned about the lives of current users and expand the remarkable achievements and experiences to non-user counterparts. [ABSTRACT FROM AUTHOR]

Introduction: In the health sector, questions are being raised about the possible threats to the accepted principles of ethics such as autonomy, beneficence, non malfeasance and justice in the delivery of health care. There is limited information in Ethiopia regarding to practice of code of ethics among medical doctors. Hence, this study aimed to assess practice of code of ethics and associated factors among medical doctors working in governmental and private hospitals in Addis Ababa, Ethiopia. Methods: Institution based cross sectional quantitative study triangulated with qualitative study was conducted among 500 medical doctors working in governmental and private hospitals and three key informants from Federal Ministry of Health, Ethiopian Food, Medicine and Healthcare Administration and Control Authority and Ethiopian Medical Association in Addis Ababa from May 8, 2017 to June 30, 2017. Data were collected using pretested self-administered structured questionnaire and semi-structured questionnaire. Binary Logistic Regression and Content Analysis methods were used for the quantitative and qualitative data analysis respectively. Results: The study showed that only 152 (30.4%) of medical doctors had good practice of code of ethics. The odds of having good practice of code of ethics among medical doctors in the age group of 25–29 years were 2.749 times the odds of those in the age group of 30–34 years (AOR = 2.749, 95% CI: 1.483, 5.096), medical doctors working in governmental hospitals were 65.4% less likely to have good practice of code of ethics compared to those working in private hospitals (AOR = 0.346, 95% CI: 0.184, 0.652), knowledgeable medical doctors were 83.5% more likely to have good practice of code of ethics compared to those who were not knowledgeable about code of ethics (AOR = 1.835, 95% CI: 0.999, 3.368), and the odds of having good practice of code of ethics among medical doctors with favourable attitude were 7.404 times the odds of those with unfavourable attitude towards code of ethics (AOR = 7.404, 95% CI: 4.254, 12.887). Furthermore lack of motivation, unfavorable working environment, working at various health facilities simultaneously, public awareness, taking courses on medical ethics, lack of unethical conduct reporting and complaint handling system, incompetence of medical doctors, and weak collaboration among key stakeholders were identified as determinants of practice of code of ethics. Conclusions: Only 30.4% of medical doctors had good practice of code of ethics. This indicates that practice of code of ethics among medical doctors in Addis Ababa is poor. The factors associated with practice of code of ethics were age, type of hospital, knowledge, attitude, lack of motivation, unfavorable working environment, working at various health facilities simultaneously, public awareness, medical ethics course, lack of unethical conduct reporting and compliant handling system, incompetence of medical doctors and weak collaboration among key stakeholders. Hence, awareness creation and attitudinal change on code of ethics by continuous training, implementation of integrated medical ethics course, enforcement of code of ethics and continuing professional development (CPD) implementation are important. [ABSTRACT FROM AUTHOR]

Background: Adolescence is characterized by rapid growth and development and iron requirements increase during this time. Adolescents with poor diet in early childhood and/or females with an early onset of menarche may be at greater risk for developing anemia due to the rapid depletion of iron stores in their bodies. Objective: The objective of this study was to assess the prevalence and severity of anemia among school adolescents in Wonago district, Gedeo Zone, South Ethiopia. Methods: A school based cross-sectional study was conducted among 443 randomly selected school adolescents across 15 schools (2 secondary schools and 13 primary schools) in the district. Hemoglobin concentration from a capillary blood sample was determined by portable hemoglobin meter (HemoCue). Descriptive statistics were computed for prevalence of anemia, anthropometric measurements, socio-economic and socio-demographic variables. A hierarchical multivariable logistic regression analysis was done to identify determinants of anemia among adolescents. Results: The prevalence of anemia among adolescents in the study area was 22%. Anemia was higher among those in early adolescence period (10–13 years) (AOR: 4.75, CI: 1.69–13.35) compared to late adolescence (17–19 years) and among those with height for age z-score less than -2 (AOR: 6.23, CI: 1.98–19.62). Similarly, anemia was higher among those in households with a family size greater than five members (AOR: 9.82, CI: 2.42–39.88), adolescents from rural areas (AOR: 4.37, CI: 1.54–12.46) and families who purchase food needed for daily consumption (AOR: 3.25, CI: 1.42–7.45). On the other hand, adolescents from middle wealth quintiles (AOR: 0.26 (CI: 0.07–0.98)) and female adolescents (AOR: 0.34 (CI: 0.15–0.79) were less likely to be anemic in this study. Conclusions: The prevalence of anemia in this population is of moderate public health concern, adolescents of both sexes are among groups at risk for the development of anemia. The need for further assessment of the etiology of anemia should be considered to design pragmatic intervention programs. [ABSTRACT FROM AUTHOR]

Anaemia is a condition in which the haemoglobin concentration falls below an established cut-off value due to a decrease in the number and size of red blood cells. The current study aimed (i) to assess the spatial pattern and (ii) to identify determinants related to anaemia using the third Ethiopian demographic health survey. To achieve these objectives, this study took into account the sampling weight and the clustered nature of the data. As a result, multilevel modeling has been used in the statistical analysis. The analysis included complete cases from 15,909 females, and 13,903 males. Among all subjects who agreed for hemeoglobin test, 5.22% males, and 16.60% females were anemic. In both binary and ordinal outcome modeling approaches, educational level, age, wealth index, BMI and HIV status were found to be significant predictors of anaemia prevalence. Furthermore, this study applied spatial methods to generate maps at regional level which could be useful for policy makers where great efforts should be concentrated to reduce the prevalence of anaemia. As revealed by Moran’s I test, significant spatial autocorrelation were noted across clusters. The risk of anaemia was found to vary across different regions, and higher prevalences were observed in Somali and Affar regions. [ABSTRACT FROM AUTHOR]

Female genital cutting (FGC) has major implications for women’s physical, sexual and psychological health, and eliminating the practice is a key target for public health policy-makers. To date one of the main barriers to achieving this has been an inability to infer privately-held views on FGC within communities where it is prevalent. As a sensitive (and often illegal) topic, people are anticipated to hide their true support for the practice when questioned directly. Here we use an indirect questioning method (unmatched count technique) to identify hidden support for FGC in a rural South Central Ethiopian community where the practice is common, but thought to be in decline. Employing a socio-demographic household survey of 1620 Arsi Oromo adults, which incorporated both direct and indirect direct response (unmatched count) techniques we compare directly-stated versus privately-held views in support of FGC, and individual variation in responses by age, gender and education and target female (daughters versus daughters-in-law). Both genders express low support for FGC when questioned directly, while indirect methods reveal substantially higher acceptance (of cutting both daughters and daughters-in-law). Educated adults (those who have attended school) are privately more supportive of the practice than they are prepared to admit openly to an interviewer, indicating that education may heighten secrecy rather than decrease support for FGC. Older individuals hold the strongest views in favour of FGC (particularly educated older males), but they are also more inclined to conceal their support for FGC when questioned directly. As these elders represent the most influential members of society, their hidden support for FGC may constitute a pivotal barrier to eliminating the practice in this community. Our results demonstrate the great potential for indirect questioning methods to advance knowledge and inform policy on culturally-sensitive topics like FGC; providing more reliable data and improving understanding of the “true” drivers of FGC. [ABSTRACT FROM AUTHOR]

Background: Delays in seeking timely appropriate care contributes to a large number of deaths from diarrhea in children. This study aimed to identify determinants of delays in seeking timely treatment by mothers/caregivers of under-five children with diarrheal diseases. Methods: We used an unmatched case-control study from February—March 2017 among 316 children: 158 cases and 158 controls. Cases were mothers/caregivers with under-five children who had signs/symptoms of diarrhea and sought treatment after 24 hours onset of symptom. Controls sought treatment within 24 hours. Field workers collected data using a pre-tested standardized questionnaire. Multivariate logistic regression was conducted to identify determinants of delay in timely diarrhea treatment seeking. Statistical significance was declared by using a p-value<0.05 and 95% of confidence interval (CI) for an adjusted-odds ratio (AOR). Results: The determinants of delay in timely treatment seeking of mothers/caregivers of under-five children with diarrheal diseases were children <24months (AOR = 1.9,95%CI:1.1–3.4); fail to attend school (AOR = 2.4, 95%CI:1.2–4.6); being female children (AOR = 1.7,95%CI:1.05–2.9); preferring government health facility for the treatment of children with diarrheal diseases (AOR = 2.9, 95%CI, 1.3–6.7); lack of past history taking children to health facility and lack of counseling (AOR = 4.8, 95%CI:2.0–12.1); being in the15-25 years age (AOR = 1.7, 95%CI:1.1–3.0) and taking children to a health facility as a first response to diarrhea (AOR = 0.1, 95%CI:0.01–0.8). Conclusions: Age of the child, maternal age, and disease related determinants were determinants for seeking timely treatment to diarrheal diseases. Providing skilled based health education and counseling to mothers/caregivers on seeking timely treatment and taking children with diarrheal diseases to a health facility as a first response to diarrhea is a paramount intervention to reduce morbidity and mortality of children. [ABSTRACT FROM AUTHOR]

Background: Heavy burden of child injuries and lack of policy response in Ethiopia call for an improved understanding of the situation and development of action plans from multiple governmental agencies and stakeholders. Methods: A consortium of international and Ethiopian researchers and stakeholders used extensive literature review and mixed analytical methods to estimate and project the burden of fatal and non-fatal child unintentional injuries in Ethiopia from 2015 to 2030. Estimates were derived for children aged 0–14 years. Data sources include a longitudinal study conducted by the Central Statistics Agency of Ethiopia and the World Bank as well as model-based estimates from World Health Organization 2017 and Global Burden of Disease 2016 project. Results: Injuries caused about 25 thousand deaths among 0-14-year olds in Ethiopia in 2015. The leading cause of fatal child unintentional injuries in Ethiopia was road-traffic injuries, followed by fire, heat and hot substances and drowning. The death rate due to injuries among 0–14 years olds was about 50 percent higher in males than females. Rural children were exposed to a greater risk of injury than their urban peers. The longitudinal survey suggests that the incidence rate of child injuries increased during the period 2011–2014. The annual mortality caused by injuries is projected to increase from 10,697 in 2015 to 11,279 in 2020 and 11,989 in 2030 among children under 5 years, an increase of 12 percentage points in 15 years. The number of deaths among 0-14-year olds will be 26,463, 27,807, and 30,364 respectively in 2015, 2020, and 2030. Conclusions: As the first multisectoral collaboration on child injuries in Ethiopia, this study identified gaps in understanding of the burden of child injuries in Ethiopia. In consultation with Ethiopian government and other stakeholders, we propose starting an injury surveillance system at health clinics and hospitals and building an intervention package based on existing platforms. [ABSTRACT FROM AUTHOR]

Background: Trachoma is chronic kerato conjunctivitis, which is caused by repeated infection with Chlamydia trachomatis bacterium. It is hyper endemic in many rural areas of Ethiopia. The objective of this study was to measure the effect of water, sanitation and hygiene interventions on active trachoma in selected woredas of North and South Wollo zones of Amhara Region, Ethiopia. Methodology: A community based quasi-experimental study was conducted from October 2014 to December 2015 among children aged 1–8 years at baseline and among one year older same children after intervention. A four-stage random cluster-sampling technique was employed to select study participants. From each selected household, one child was clinically assessed for active trachoma. Structured questionnaire was used to collect socio demographic and behavioral data. MacNemar test was applied to compare the prevalence of active trachoma between baseline and after the intervention period at both intervention and non-intervention study areas. Results: The prevalence of active trachoma was reduced from baseline prevalence of 26% to 18% after one-year intervention period in the intervention woredas (P≤0.001). MacNemar test result showed significant reduction of active trachoma prevalence after the intervention period in the intervention woredas compared to the non-intervention woredas (P≤0.001). Water, sanitation and hygiene related activities were significantly improved after the intervention period in the intervention woredas (P<0.05). Conclusions: There was a significant reduction of active trachoma prevalence between the baseline and after the intervention period in the intervention woredas, but not in the non-intervention ones. Improved water, sanitation and hygiene interventions contributed to the reduction of active trachoma. However, the magnitude of active trachoma prevalence observed after the intervention is still very high in the studied areas of North and South Wollo Zones communities. To achieve the global trachoma elimination target by the year 2020 as set by the WHO, continued WaSH interventions and periodic monitoring, evaluation and reporting of the impact of WaSH on active trachoma is warranted. [ABSTRACT FROM AUTHOR]

Endemicity mapping is required to determining whether a district requires mass drug administration (MDA). Current guidelines for mapping LF require that two sites be selected per district and within each site a convenience sample of 100 adults be tested for antigenemia or microfilaremia. One or more confirmed positive tests in either site is interpreted as an indicator of potential transmission, prompting MDA at the district-level. While this mapping strategy has worked well in high-prevalence settings, imperfect diagnostics and the transmission potential of a single positive adult have raised concerns about the strategy’s use in low-prevalence settings. In response to these limitations, a statistically rigorous confirmatory mapping strategy was designed as a complement to the current strategy when LF endemicity is uncertain. Under the new strategy, schools are selected by either systematic or cluster sampling, depending on population size, and within each selected school, children 9–14 years are sampled systematically. All selected children are tested and the number of positive results is compared against a critical value to determine, with known probabilities of error, whether the average prevalence of LF infection is likely below a threshold of 2%. This confirmatory mapping strategy was applied to 45 districts in Ethiopia and 10 in Tanzania, where initial mapping results were considered uncertain. In 42 Ethiopian districts, and all 10 of the Tanzanian districts, the number of antigenemic children was below the critical cutoff, suggesting that these districts do not require MDA. Only three Ethiopian districts exceeded the critical cutoff of positive results. Whereas the current World Health Organization guidelines would have recommended MDA in all 55 districts, the present results suggest that only three of these districts requires MDA. By avoiding unnecessary MDA in 52 districts, the confirmatory mapping strategy is estimated to have saved a total of $9,293,219. [ABSTRACT FROM AUTHOR]

Background: Ethiopia is one of the developing countries with the poorest health status and the health services utilization is generally low with different patterns in different regions of the country. Therefore, the aim of this study was to assess utilization of modern health services and associated factors in Dessie, Ethiopia. Methods: A cross sectional study design was employed from January to March, 2015 in Dessie City. The total sample was 420 adults. Adults were selected by stratified random sampling. The strata were made using residence as urban and rural residents. The data was collected using pre-tested, interviewer administered questionnaire. The data was entered into Epi infoTM7 software and exported to Statistical Package for Social Sciences (SPSS) version 20 Software for analysis. Binary logistic regression was used to evaluate independent effect of each variable on modern health service utilization by controlling the effect of others. The strength of association between dependent variable and independent variables was expressed by odds ratio with 95% confidence interval. Results: The overall modern health services utilization rate was 41.8%. Being Female sex, annual income greater than poverty line, poor perception of health status, high perceived severity of illness, two or more than two number of illnesses in the last 12 months prior to the survey and presence of chronic health problem were found to have a significant association with utilization of modern health services. Conclusion: Modern health services utilization was found to be low. Being female sex, annual income above poverty line, having poor perceived health status, having two or more than two illnesses, severe perceived severity of illness and having chronic health problem were found to have a statistically significant association with utilization. Therefore, efforts have to be made to increase utilization of modern health services through establishing systems like health extension workers and health development army. [ABSTRACT FROM AUTHOR]

Background: Infections with Schistosoma mansoni and soil-transmitted helminthes (STHs) are major public health problems in Ethiopia. However, information was scarce on the current status of these infections to guide an intervention in the study area. Therefore, this study was conducted to assess the prevalence of infections with S. mansoni and STHs and associated factors among school children in southern Ethiopia. Methods: This cross-sectional study investigated children who were attending the Finchawa and Tullo junior elementary schools and were residing along the shore of the lake Hawassa in January and February, 2015. A total of 374 students were selected using systematic random sampling technique. Data on socio-demography and related factors was collected using structured questionnaires. A single stool sample was collected from each child and processed using formol-ether concentration technique and examined microscopically for parasites’ ova/larva. Results: The prevalence of parasitic infection with one or more than one helminthiasis was found to be 67.9%. Seven different types of helminths were identified and the most prevalent parasites were Ascaris lumbricoides (44.4%), followed by S. mansoni (31%), Trichuris trichiura (11%), and hookworms (7.7%). The rate of infection with STHs was 52.4%. Single, double, triple and quadruple infections were 42.2, 22.5, 2.4, and 0.8%, respectively. Children who practiced open-field defecation (AOR, 3.6; 95% CI 1.6–8.0; p = 0.001) and had not always washed their hands before eating a meal (AOR, 5.0; 95%CI 2.15–11.7; p <0.001) were more infected with STHs. Moreover, the rate of S. mansoni infection was significantly higher among children who were attending the Finchawa school (AOR, 2.13; 95% CI 1.31–3.46; p = 0.002), aged 11–15 years (AOR, 1.97; 95% CI 1.22–3.19; p = 0.006), had swum in the lake Hawassa (AOR, 2.73; 95%CI 1.20–6.17; p = 0.016), and had involved in irrigation-related activities (AOR, 1.68; 95%CI 1.04–2.71; p = 0.034). Conclusion: The study showed high prevalence of STHs and moderate rate of schisotosomiasis. Mass deworming twice a year for STHs and once every two years for S. mansoni, further to strengthening other prevention measures, is critically needed to reduce these infections to inconsequential level. [ABSTRACT FROM AUTHOR]

Introduction: Despite its proven benefit in reducing child mortality and morbidity, the coverage of exclusive breastfeeding (EBF) remains sub-optimal. In Ethiopia, about 52% of infants under six months of age were exclusively breastfed, implying the need for further identification of the barriers to optimal EBF practice. Therefore, this study aimed to investigate EBF and its determinants in the predominantly rural northwest Ethiopia. Methods: The study was conducted at the Dabat Health and Demographic Surveillance System (HDSS) site, which is located in Dabat District, northwest Ethiopia. A total of 5,227 mothers with children under five years of age were included for analysis. Multivariable binary logistic regression analysis was employed to identify factors associated with EBF. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was estimated to show the strength of association. A P-value of <0.05 was used to declare statistical significance. Results: About 54.5% [95% CI: 51.9, 57.1] of the mothers practiced EBF. Mothers' education [AOR = 2.10; 95% CI: 1.63, 2.71], age (20–35 years) [AOR = 1.39; CI: 1.07, 1.80], urban residence [AOR = 1.28; 95% CI: 1.07, 1.54], at least one ANC visit [AOR = 1.41; 95% CI: 1.23,1.61], initiation of breastfeeding within one hour of birth [AOR = 1.32; 95% CI: 1.15,1.50], richer household [AOR = 1.34; 95% CI: 1.07, 1.65], and withholding prelacteal feeds [AOR = 1.34; 95% CI: 1.17, 1.53] were found important determinants of EBF. Conclusion: In this study area, the prevalence of EBF is lower than the national as well as the global recommendation for universal coverage of EBF. Therefore, strengthening the implementation of Infant and Young Child Feeding strategy (IYCF) and maternal health care utilization are essential for stepping up EBF coverage. Moreover, attention should be given to uneducated, rural resident, and adolescent mothers. [ABSTRACT FROM AUTHOR]

Methodologies to measure gender-based violence (GBV) have received inadequate attention, especially in humanitarian contexts where vulnerabilities to violence are exacerbated. This paper compares the results from individual audio computer-assisted self-administered (ACASI) survey interviews with results from participatory social mapping activities, employed with the same sample in two different post-conflict contexts. Eighty-seven internally displaced adolescent girls from the Democratic Republic of the Congo and 78 Sudanese girls living in Ethiopian refugee camps were interviewed using the two methodologies. Results revealed that the group-based qualitative method elicited narratives of violence focusing on events perpetrated by strangers or members of the community more distantly connected to girls. In contrast, ACASI interviews revealed violence predominantly perpetrated by family members and intimate partners. These findings suggest that group-based methods of information gathering frequently used in the field may be more susceptible to socially accepted narratives. Specifically, our findings suggest group-based methods may produce results showing that sexual violence perpetrated by strangers (e.g., from armed groups in the conflict) is more prevalent than violence perpetrated by family and intimate partners. To the extent this finding is true, it may lead to a skewed perception that adolescent GBV involving strangers is a more pressing issue than intimate partner and family-based sexual violence, when in fact, both are of great concern. [ABSTRACT FROM AUTHOR]

Background: Most of child mortality and under nutrition in developing world were attributed to suboptimal childcare and feeding, which needs detailed investigation beyond the proximal factors. This study was conducted with the aim of assessing associations of women’s autonomy and men’s involvement with child anthropometric indices in cash crop livelihood areas of South West Ethiopia. Methods: Multi-stage stratified sampling was used to select 749 farming households living in three coffee producing sub-districts of Jimma zone, Ethiopia. Domains of women’s Autonomy were measured by a tool adapted from demographic health survey. A model for determination of paternal involvement in childcare was employed. Caring practices were assessed through the WHO Infant and young child feeding practice core indicators. Length and weight measurements were taken in duplicate using standard techniques. Data were analyzed using SPSS for windows version 21. A multivariable linear regression was used to predict weight for height Z-scores and length for age Z-scores after adjusting for various factors. Results: The mean (sd) scores of weight for age (WAZ), height for age (HAZ), weight for height (WHZ) and BMI for age (BAZ) was -0.52(1.26), -0.73(1.43), -0.13(1.34) and -0.1(1.39) respectively. The results of multi variable linear regression analyses showed that WHZ scores of children of mothers who had autonomy of conducting big purchase were higher by 0.42 compared to children's whose mothers had not. In addition, a child whose father was involved in childcare and feeding had higher HAZ score by 0.1. Regarding age, as for every month increase in age of child, a 0.04 point decrease in HAZ score and a 0.01 point decrease in WHZ were noted. Similarly, a child living in food insecure households had lower HAZ score by 0.29 compared to child of food secured households. As family size increased by a person a WHZ score of a child is decreased by 0.08. WHZ and HAZ scores of male child was found lower by 0.25 and 0.38 respectively compared to a female child of same age. Conclusion: Women’s autonomy and men’s involvement appeared in tandem with better child anthropometric outcomes. Nutrition interventions in such setting should integrate enhancing women’s autonomy over resource and men’s involvement in childcare and feeding, in addition to food security measures. [ABSTRACT FROM AUTHOR]

Background: Diabetes kills more than 4.9 million adults per year. It becomes rapidly increasing, non-communicable disease—a major threat to global public health particularly in Sub-Saharan Africa. Though previous studies among diabetic patients were focused in health institution, limited knowledge, attitude and practice were seen. There is no study conducted about diabetes related to knowledge, attitudes, practice and associated factors in the community level. Objective of the study: The study assessed knowledge, attitude, practices, and its associated factors towards diabetes mellitus among non diabetic community members of Bale Zone, Ethiopia. Methods: Community based cross-sectional study was conducted from November 15 to December 15, 2015 among 605 non diabetic community members of Bale Zone administrative towns. Data was collected using pretested structured face-to-face interview after taking informed written consent. Respondents were selected by systematic random sampling. The data was entered into EPI data version 3.1 and analyzed using Statistical package for social sciences version 20. Odds ratio and 95% confidence interval were calculated and P<0.05 was considered statistically significant. Finally, multivariable logistic regression analysis was performed to indicate the independent predictors of knowledge, attitude and practice. Result: Response rate of the study was 98.2%. About 52.5% of participants were knowledgeable, 55.9% and 56.6% had good attitude and practice respectively. Earning average monthly family income of ≤500 Ethiopian birr (AOR = 0.4, CI = 0.2, 0.6) and 501–1000 (AOR = 0.4, CI = 0.2, 0.7), heard about diabetes (AOR = 4.4, CI = 1.9, 10.2), had diabetes health education exposure (AOR = 5, CI = 2.5, 9.7) resulted to have good diabetes knowledge. Student, (AOR = 5.1, CI = 2.1,12), government/private employee (AOR = 3,CI = 1.4,6.7), merchant (AOR = 2,CI = 1.1,3.6) and Knowledgeable (AOR = 3, CI = 2.1, 4.7) subjects had positive attitude towards diabetes. Having college and above educational level (AOR = 0.33, CI = 0.16, 0.7), having good attitude towards diabetes (AOR = 2, CI = 1.3, 3) had good practiced. Conclusion: Considerable limited knowledge, attitude and practices were seen. A great emphasis on health education regarding symptoms and risk factors modification for diabetes are necessary. [ABSTRACT FROM AUTHOR]

This paper examines the effects of maternal autonomy on child schooling outcomes in Ethiopia using a nationally representative Ethiopian Demographic and Health survey for 2011. The empirical strategy uses a Hurdle Negative Binomial Regression model to estimate years of schooling. An ordered probit model is also estimated to examine age grade distortion using a trichotomous dependent variable that captures three states of child schooling. The large sample size and the range of questions available in this dataset allow us to explore the influence of individual and household level social, economic and cultural factors on child schooling. The analysis finds statistically significant effects of maternal autonomy variables on child schooling in Ethiopia. The roles of maternal autonomy and other household-level factors on child schooling are important issues in Ethiopia, where health and education outcomes are poor for large segments of the population. [ABSTRACT FROM AUTHOR]

Background: Stigma towards people with mental illness (PWMI) can result in low self-esteem and isolation and threaten employment. Therefore, this study aimed to assess the magnitude of public stigma against PWMI and factors associated with it among Jimma town residents. Methods: A community-based, cross-sectional, descriptive study was conducted in adult residents of Jimma town. Data were collected among 820 randomly selected residents with the interviewer-administered Community Attitudes toward the Mentally Ill (CAMI) scale. Linear regression analyses were performed to identify predictors of stigma against PWMI. Result: A total of 444 (54%) of the 820 respondents were females, and the mean (SD) age was 35 (8.5) years. The minimum and maximum possible values on each CAMI subscale were 10 and 50, respectively. The respondents had high scores for a stigmatizing attitude towards PWMI across all the subscales, as indicated by the mean (SD) scores: authoritarianism, 27.17 (4.96); social restrictiveness, 32.41 (4.20); benevolence, 35.34 (4.42); and community-based mental health ideology, 33.95 (5.82). Compared to housewives, private organization employees showed more autocratic and socially restrictive views (std. β = 1.12, P<0.01). Single people had a lower social restrictiveness stigma score than married people (std. β = -0.20, P<0.001), and participants’ academic levels correlated inversely with the stigma score (std. β = -0.12, P<0.001). A higher benevolence stigma score was observed among participants with no relationship with PWMI than among those with PWMI in their neighborhood (std. β = 0.08, P< 0.046). Conclusion: The study revealed that a negative attitude towards PWMI is widespread. Therefore, there is a need to develop strategies to fight the stigma attached to PWMI at the community level. [ABSTRACT FROM AUTHOR]

Background: Nurse–physician communication has been shown to have a significant impact on the job satisfaction and retention of staff. In areas where it has been studied, communication failure between nurses and physicians was found to be one of the leading causes of preventable patient injuries, complications, death and medical malpractice claims. Objective: The objective of this study is to determine perception of nurses and physicians towards nurse-physician communication in patient care and associated factors in public hospitals of Jimma zone, southwest Ethiopia. Methods: Institution based cross-sectional survey was conducted from March 10 to April 16, 2014 among 341 nurses and 168 physicians working in public hospitals in Jimma zone. Data was collected using a pre-tested self-administered questionnaire; entered into EpiData version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 16.0 for analysis. Factor analysis was carried out. Descriptive statistics, independent sample t-test, linear regression and one way analysis of variance were used. Variables with P-value < 0.05 were considered as statistically significant. Results: The response rate of the study was 91.55%. The mean perceived nurse-physician communication scores were 50.88±19.7% for perceived professional respect and satisfaction, and 48.52±19.7% for perceived openness and sharing of patient information on nurse-physician communication. Age, salary and organizational factors were statistically significant predictors for perceived respect and satisfaction. Whereas sex, working hospital, work attitude individual factors and organizational factors were significant predictors of perceived openness and sharing of patient information in nurse-physician communication during patient care. Conclusion: Perceived level of nurse-physician communication mean score was low among nurses than physicians and it is attention seeking gap. Hence, the finding of our study suggests the need for developing and implementing nurse-physician communication improvement strategies to solve communication mishaps in patient care. [ABSTRACT FROM AUTHOR]

Background: Currently in Ethiopia, young people’s sexual and reproductive health services are limited and there is a growing issue of confidentiality and affordability of these health services. Moreover, the available services provided are not sensitive to the special needs of young people. Therefore, this study was aimed to assess young people’s sexual and reproductive health service utilization and its associated factors in Awabel district, Northwest Ethiopia. Methods: A community based cross-sectional study was conducted among 781 randomly selected young people using a pre-tested structured questionnaires in Awabel district, Northwest Ethiopia. Data were entered into Epi data version 3.1 and analyzed using SPSS version 16.0 software. Results: The mean age of respondents were 17.80 (+ 2.65) years. About 41% of young people had utilized sexual and reproductive health services. Young people from families of higher family expenditure, lived with mothers, participated in peer education and lived near to a Health Center were more likely to utilize sexual and reproductive health services. Furthermore, those who had a parental discussion on sexual and reproductive health (AOR (95% C.I): 2.23 (1.43, 3.46)) and ever had sexual intercourse (AOR (95% C.I): 1.88 (1.30, 2.71)) were more likely to utilize the service than their counterparts. On the other hand, those young people lived with their father and had a primary level of educational attainment was less likely to utilize the service. Conclusion: Utilization of sexual and reproductive health services is low which needs a great attention where; if not intervened, young people might engage in risky sexual activities. Therefore, it needs a concerted effort from all the concerned bodies to improve their service utilization and thereby reduce the burden of young people’s disease and disabilities associated with sexual and reproductive health. [ABSTRACT FROM AUTHOR]

Background: Community-based randomized controlled trials are often complex pieces of research with significant challenges around the approach to the community, information provision, and decision-making, all of which are fundamental to the informed consent process. We conducted a rapid ethical assessment to guide the preparation for and conduct of a randomized controlled trial of podoconiosis treatment in northern Ethiopia. Methods: A qualitative study was carried out in Aneded woreda, East Gojjam Zone, Amhara Regional State from August to September, 2013. A total of 14 In-depth Interviews (IDIs) with researchers, experts, and leaders, and 8 Focus Group Discussions (FGDs) involving 80 participants (people of both gender, with and without podoconiosis), were conducted. Interviews were carried out in Amharic. Data analysis was started alongside collection. Final data analysis used a thematic approach based on themes identified a priori and those that emerged during the analysis. Results: Respondents made a range of specific suggestions, including that sensitisation meetings were called by woreda or kebele leaders or the police; that Health Extension Workers were asked to accompany the research team to patients’ houses; that detailed trial information was explained by someone with deep local knowledge; that analogies from agriculture and local social organisations be used to explain randomisation; that participants in the ‘delayed’ intervention arm be given small incentives to continue in the trial; and that key community members be asked to quell rumours arising in the course of the trial. Conclusion: Many of these recommendations were incorporated into the preparatory phases of the trial, or were used during the course of the trial itself. This demonstrates the utility of rapid ethical assessment preceding a complex piece of research in a relatively research-naive setting. [ABSTRACT FROM AUTHOR]

Background: Mental illnesses worldwide are accompanied by another pandemic, that of stigma and discrimination. Public understanding about mental illnesses and attitudes towards people with mental illness play a paramount role in the prevention and treatment of mental illness and the rehabilitation of people with mental illness. Objective: To assess community attitude and associated factors towards people with mental illness. Methods: Community based cross-sectional study was conducted from April 28 to May 28, 2014. Quantitative data were collected through interview from 435 adults selected using simple random sampling. Data were collected using community attitude towards mentally ill (CAMI) tool to assess community attitude towards people with mental illness and associated factors. Multiple linear regression analysis was performed to identify predictors of community attitude towards people with mental illness and the level of significance association was determined by beta with 95% confidence interval and P less than 0.05. Results: The highest mean score was on social restrictiveness subscale (31.55±5.62). Farmers had more socially restrictive view (β = 0.291, CI [0.09, 0.49]) and have less humanistic view towards mentally ill (β = 0.193, CI [-0.36, -0.03]). Having mental health information had significantly less socially restrictive (β = -0.59, CI [-1.13, -0.05]) and less authoritarian (β = -0.10, CI [-1.11, -0.06]) view towards mentally ill but respondents who are at university or college level reported to be more socially restrictive (β = 0.298, CI [0.059, 0.54]). Respondents whose age is above 48 years old had significantly less view of community mental health ideology (β = -0.59, CI [-1.09, -0.08]). Conclusion and Recommendation: Residents of Worabe town were highly socially restrictive but less authoritarian. There was high level of negative attitude towards people with mental illness along all the subscales with relative variation indicating a need to develop strategies to change negative attitude attached to mental illness in Worabe town at community level. [ABSTRACT FROM AUTHOR]

Introduction: The HIV prevalence rate in Ethiopia for married (or cohabiting) women is 3 times that found amongst women who have never been married. While marriage used to be seen as a protective factor against HIV, evidence suggests that this is no longer necessarily the case. This study analyses the trend and socio-demographic determinants of HIV awareness and safe sex negotiation among married women in Ethiopia between 2005 and 2011. Methods: Data from Ethiopian Demographic and Health Surveys conducted in 2005 and in 2011 were analysed. Socio-demographic variables as well as ‘survey year’ were selected to assess their interaction with selected HIV awareness and safe sex negotiation indicators. Multivariable regression analyses were performed. Odds ratios and confidence intervals were computed. Results: A significant increase in knowledge of HIV and ability to negotiate safer sex occurred between 2005 and 2011 reflecting a positive trend in gender empowerment amongst married Ethiopian women. Some of these advancements were striking, for instance respondents were 3.6 times more likely to have “Heard of AIDS” in 2011 than in 2005. HIV awareness and safer sex negotiation were significantly associated with higher education, higher socioeconomic status, those who had heard of HIV, those of the Orthodox Christian faith, and (to some extent) those living in rural areas. Conclusion: HIV awareness has increased significantly in Ethiopia over the last decade but married women are still disproportionately susceptible to HIV. Community programmes, already effective in Ethiopia, also need to target this vulnerable sub-group of women. [ABSTRACT FROM AUTHOR]

Background: Low birth weight (LBW) is the principal risk factor for neonatal and infant mortality in developing countries. This study examines the effects of unwanted pregnancy, prenatal depression and social support on the risk of low birth weight in rural southwestern Ethiopia. We hypothesized that unwanted pregnancy and prenatal depression increase the risk of low birth weight, while social support mediates this association. Methods: Data for the study comes from a prospective study in which women were followed from pregnancy through to delivery. Six hundred twenty two women were followed and 537 birth weights were measured within 72 hours. Multivariable log binomial regression was used to model the risk of low birth weight. Results: The mean birth weight was 2989 grams (SD±504 grams), and the incidence of LBW was 17.88%. The mean birth weight of babies after unwanted pregnancy was 114 g lower compared to births from intended pregnancy. Similarly, mean birth weight for babies among women with symptoms of antenatal depression was 116 grams lower. Results of unadjusted log-binomial regression showed that unwanted pregnancy, prenatal depression and social support were associated with LBW. The relationship between antenatal depressive symptoms and LBW was mediated by the presence of social support, while the association between LBW and unwanted pregnancy remained after multivariable adjustment. Conclusion: The incidence of low birth weight is high in the study area. Poverty, nonuse of antenatal care, low social support and unwanted pregnancy contribute to this high incidence of low birth weight. Hence, identifying women’s pregnancy intention during antenatal care visits, and providing appropriate counseling and social support will help improve birth outcomes. [ABSTRACT FROM AUTHOR]