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Ethiopia is a high-tuberculosis (TB) burden country with 157 new cases per 100,000 people, with 23,800 TB-related deaths in 2020. In Ethiopia, TB patients have different healthcare-seeking behaviors. They frequently visit spiritual places, such as holy water sites (HWSs), to seek treatment for their illness spiritually. This study examined the prevalence of pulmonary TB (PTB) and drug susceptibility profiles of Mycobacterium tuberculosis (MTB) isolates among spiritual HWS attendees in Northwest Ethiopia. A cross-sectional study was conducted from June 2019 to March 2020. Sputum samples were collected, processed, and cultured using Löwenstein–Jensen (LJ) culture medium. Second-generation line probe assays (LPAs), GenoType®MTBDRplus VER2.0 and GenoType®MTBDRsl VER2.0, were used to detect anti-TB drug-resistant isolates. STATA 17 was utilized to perform descriptive statistics, bivariate, and multivariate regression analyses. Of 560 PTB-symptomatic participants, 21.8% ((95% confidence interval (95 CI): 18.4–25.2%)) were culture-positive, resulting in a point prevalence of 1,183/100,000 attendees. Amongst HWS attendees, culture-positive TB occurred most commonly in persons 18–33 years of age (28.5% (95 CI 23.4–34.3%)). Other participant characteristics significantly associated with culture-positive PTB were as follows: rural residents (adjusted odds ratio (aOR) 2.65; 95 CI 1.38–5.10), married participants (aOR 2.43; 95 CI 1.28–4.63), family members >5 per household (aOR 1.84; 95 CI 1.04–3.24), and sharing living space (aOR 10.57; 95 CI 3.60–31.13). Also, among 438 participants followed for 12 months after showing negative TB culture results while at the HWS, 6.8% (95 CI 4.4–9.4%) developed or contracted culture-positive TB post-residency at the HWSs. Of the 122 tested isolates, 20 (16.4%) were isoniazid (INH) and/or rifampicin (RIF) resistant. Multidrug-resistant (MDR) TB was detected in 15 cases (12.3%), five of which were fluoroquinolones (FLQs) resistant. The findings from this study should raise a concern about HWSs as potential high-risk settings for TB transmission. It is recommended that appropriate control measures be instituted that include compulsory TB testing and tightened infection control at HWSs, where an increased risk exists for transmission of TB. [ABSTRACT FROM AUTHOR]

Observers of Ethiopia's entry into export-oriented global value chains generally agree that social upgrading is crucial if these chains' largely female workforce is to reap the benefits of participation. They disagree, however, on the extent to which a 'business case' can be made to involve in this upgrading the managers who link frontline workers to international buyers. This article takes a novel approach to these questions by directly asking these managers and those who advise them on human resources how they understand the well-being of their frontline workers. Drawing on 37 qualitative semi-structured interviews, we find great variation in the extent to which such actors are interested in pursuing worker well-being and social upgrading beyond basic compliance. This is indeed due in part to the sectoral dynamics that have shaped managers' views of what constitutes a profitable labour regime but also by sociocultural factors that include managers' own national contexts, gender and class. [ABSTRACT FROM AUTHOR]

SUMMARY: In this work of creative nonfiction, I use a visit to an Ethiopian shoe factory, where I observed the application of Japanese methods of productivity, as a lens to reflect on the ambiguities, inconsistencies, and ethical dilemmas thrown up both by such fieldwork and the larger project of promoting industrialization in Ethiopia. The reader is introduced to the cast of characters present that day and invited to follow many of them into settings beyond the factory floor. In listening to this polyphony of voices and trying to shape them into something legible in my writing, I find a parallel in the efforts of my academic field—development studies—to formulate interventions and policy prescriptions in the face of incomplete and conflicting information. The result is a cautious step towards hope and optimism and away from paralysis and despair: perhaps we can do no more than stitch together the collected parts and offer them for others to try on, but perhaps this is enough. This reflection can be read as a companion piece to my full‐length research article on the subject (Fourie 2020). [fieldwork, ethnography, Ethiopia, development studies, creative nonfiction] [ABSTRACT FROM AUTHOR]

In recent years, the European Union (EU) and other donors have increasingly instrumentalised their development cooperation to meet their own domestic migration policy goals, under the assumption that different development interventions—such as building climate resilience – may result in less outward migration from the recipient country. However, it is not yet understood how increased climate resilience would influence individual migration aspirations and capabilities. We conducted 32 in-depth interviews (IDI) and eight focus group discussions (FGD) with beneficiaries of the EU RESET Plus climate-resilience building project in southern Ethiopia. Half of the respondents are adult direct beneficiaries, and the other half are indirect beneficiaries (youths 17–24 years old). By applying a modified aspirations-capabilities framework, we extended the migration-development nexus to climate change and climate-resilience building. We found that climate change worsened perceived conditions and prospects for the future, while the development intervention mostly reinforced already emerging migration aspirations. By improving agricultural output in the context of climate variability, the RESET Plus project contributed to supporting people who wanted to stay to actually be able to do so but also encouraging those wanting to leave by slightly increasing migration capabilities. [ABSTRACT FROM AUTHOR]

We describe a series of 8 patients who had total reconstruction of the nose during 4 separate missions to Ethiopia. The aetiology was noma (n = 3), assault (n = 2), acid burn (n = 1), squamous cell carcinoma (n = 1), and a sequela of meningococcal septicaemia (n = 1). Reconstruction was with forehead flaps when adequate tissue was available (n=6) and with radial forearm flaps when it was not (n=2). Some reconstructive approaches require procedures to be done in stages, and in settings where resources are limited, difficulties with the continuity of care and provision for the management of complications, must be overcome. [ABSTRACT FROM AUTHOR]

Abstract: Around the world there is a small industry of non-governmental organisations that provide health care in niche areas that cannot be met by national health care provision. One topic is facial deformity that can have a dramatic effect on quality of life. In this study we investigate the morbidity and outcome of a British surgical team working for a 2-week period in Ethiopia. Thirty-five patients who presented with facial deformities had 47 operations during a 2-week period. Data were recorded for a minimum of 3 weeks postoperatively. Operative techniques were classified as simple or complex. Postoperative complications were assessed and classified as major, intermediate, and minor. In addition, the character of each complication was recorded and the cause elucidated. After 3 weeks the clinical objectives had been achieved in 14/17 who had simple procedures but in only 5/18 who had complex operations (p =0.004). We conclude that complex procedures are technically possible within an under-privileged health care system but successful outcome depends on paying attention to multiple factors in patients’ care and wound management. Early outcome studies may be a useful way to measure the quality of humanitarian surgical missions. [Copyright &y& Elsevier]

The genetic diversity of Mycobacterium tuberculosis complex (MTBC) strains was characterized among isolates from individuals with pulmonary tuberculosis (PTB) symptoms attended holy water sites (HWSs) in the Amhara region, Ethiopia. A cross-sectional study was done from June 2019 to March 2020 to describe the genetic diversity and drug-resistance profiles of MTBC isolates. Sputum specimens were collected and cultured in the Löwenstein-Jensen culture medium. Line Probe Assay, MTBDR plus VER 2.0, and MTBDR sl VER 2.0 were used to detect first-and second-line anti-TB drug-resistance patterns. A spoligotyping technique was utilized to characterize the genetic diversity. Statistical analysis was performed using STATA 15. Of 560 PTB-symptomatic participants, 122 (21.8%) were culture-positive cases. Spoligotyping of 116 isolates revealed diverse MTBC sublineages, with four major lineages: Euro-American (EA) (Lineage 4), East-African-Indian (EAI) (Lineage 3), Ethiopian (ETH) (Lineage 7), East Asian (EA) (Lineage 2). The majority (96.6%) of the isolates were EA (lineage 4) and EAI, with proportions of 54.3% and 42.2%, respectively. A total of 31 spoligotype patterns were identified, 26 of which were documented in the SITVIT2 database. Of these, there were 15 unique spoligotypes, while eleven were grouped with 2-17 isolates. SIT149/T3-ETH (n = 17), SIT26/CAS1-DELHI (n = 16), SIT25/CAS1-DELHI (n = 12), and SIT52/T2 (n = 11) spoligotypes were predominant. A rare spoligotype pattern: SIT41/Turkey and SIT1/Beijing, has also been identified in North Shewa. The overall clustering rate of sub-lineages with known SIT was 76.4%. Of the 122 culture-positive isolates tested, 16.4% were resistant to rifampicin (RIF) and/or isoniazid (INH). Multidrug-resistant TB (MDR-TB) was detected in 12.3% of isolates, five of which were fluoroquinolones (FLQs) resistant. SIT149/T3-ETH and SIT21/CAS1-KILI sublineages showed a higher proportion of drug resistance. Diverse MTBC spoligotypes were identified, with the T and CAS families and EA (lineage 4) predominating. A high prevalence of drug-resistant TB, with SIT149/T3-ETH and CAS1-KILI sublineages comprising a greater share, was observed. A study with large sample size and a sequencing method with stronger discriminatory power is warranted to understand better the genetic diversity of circulating MTBC in this cohort of study, which would help to adopt targeted interventions. • SIT149/T3-ETH (n = 17), SIT26/CAS1-DELHI (n = 16), and SIT25/CAS1-DELHI (n = 12) spoligotypes were predominant. • A rare spoligotype pattern: SIT41/Turkey and SIT1/Beijing, has also been identified in North Shewa. • SIT149/T3-ETH and SIT21/CAS1-KILI sublineages showed a higher proportion of drug resistance. [ABSTRACT FROM AUTHOR]