Search

Background: Evidence generated on utilization of maternal health services during times of conflict can inform the development of targeted interventions. The deadly war in Tigray caused the health system to collapse. However, utilization of maternal health services is not well documented that might help in design effective interventions applicable during armed conflict. Thus, this study aimed to assess maternal health service utilization and bridge the gap in healthcare provision and support during conflict.. Methods: A community-based cross-sectional survey was conducted among mothers of children under the age of 1 year in six accessible zones of Tigray from August 4–20, 2021. The study participants were selected through a random sampling method. The study was conducted during the armed conflict where the access to health services was limited due to the damaged and looted health facilities. A descriptive study was used to characterize the study population and data were presented using proportions and percentages. A Chi-square test was used for categorical variables and a P-value of 0.05 was considered significant.. Results: A total of 4,381 participants were included in the study. Modern contraceptives were used by 1002 (22.9%) of women, and injectable contraceptives were the most common method used by 472 (47.1%) women. Likewise, only 830 (36.5%),1956 (47.1%), and 623 (15.0%) respondents reported the use of optimal antenatal care (ANC), skilled delivery, and postnatal care (PNC) in the first 24 h by mothers, respectively. About 34% of women received comprehensive abortion care services. Most delivery services took place in hospitals. Residence has shown a significant difference in using maternal health services at p-value < 0.001. Conclusion: The conflict in Tigray has had a profound impact on maternal health services, resulting in a significant disruption that is disproportionately high in rural areas. Immediate action is required to provide access to lifesaving interventions for basic maternal health services. The timely initiation of these services is crucial in addressing the pressing needs of pregnant women and their infants. By implementing comprehensive and targeted interventions, we can mitigate the potential long-term consequences and ensure that maternal health services are effectively reinstated. [ABSTRACT FROM AUTHOR]

Although teff (Eragrostis tef) is a very important staple food crop in Ethiopia, its production is constrained by low productivity due to poor access and adoption rate of improved seed by farmers. The government of Ethiopia envisions realizing an efficient teff value chain that enables a sustainable increase of smallholder teff productivity. As a result, the government is supporting seed producer cooperatives (SPCs) to supply improved teff seeds to farmers. The aim of this study is to compare teff productivity at household level among members and nonmembers of SPCs. To this end, a cross‐sectional survey design with multi‐stage sampling method was used to select 386 sample households (193 SPC members and 193 nonmembers). As membership in a cooperative is voluntary, farmers may self‐select into a given SPC according to their own motivation and interest. In a bid to address the potential issue of selection bias from both observed and unobserved heterogeneities, we employ the treatment effects model (TEM), which allows for a specific correlation structure between the unobservables that affect the treatment and the unobservables that affect the potential outcomes. Results show that, on average, SPC members produce 1.406 more quintals per hectare compared with their nonmember counterparts. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a major public health concern in the developing countries. Moreover, the emergence of multidrug-resistant tuberculosis is challenging. However, there are no organized data on the trends of pulmonary tuberculosis and rifampicin-resistant Mycobacterium tuberculosis in the study area. Methods: A retrospective cross-sectional study was conducted to fill the information gap in Central Tigray at St. Mary General Hospital between 2018 and 2023. Data were collected from the GeneXpert™ tuberculosis registration logbooks using standard checklists and analyzed using Statistical Package for Social Science version 22. After performing logistic regression, a p-value < 0.05 with a corresponding 95% confidence interval was considered statistically significant. Moreover, chi square test for trend was performed to assess the percentage of annual detection of pulmonary tuberculosis and rifampicin-resistant Mycobacterium tuberculosis during the study years. Result: Presumptive pulmonary tuberculosis patients with complete data (n = 3696) were included in the study. The overall prevalence of pulmonary tuberculosis was 11.7%, of which 8.1% were resistant to rifampicin. The study revealed that the incidence of pulmonary tuberculosis has been increasing, mainly in the recent four years. Likewise, an increase in rifampicin-resistant Mycobacterium tuberculosis was observed with considerable fluctuations. Age, human immunodeficiency virus infection, and presumptive rifampicin-resistant Mycobacterium tuberculosis infection were significantly associated with the presence of pulmonary tuberculosis. Moreover, pulmonary tuberculosis was more prevalent among participants in the productive-age group. Conclusion: Although there have been fluctuations, an increasing of pulmonary tuberculosis and rifampicin-resistant Mycobacterium tuberculosis has been observed in recent years. Hence, prevention and treatment strategies for tuberculosis should be strengthened to alleviate the burden of pulmonary tuberculosis and rifampicin-resistant Mycobacterium tuberculosis in the study area. [ABSTRACT FROM AUTHOR]

Optimizing agricultural crop production involves utilizing proper irrigation and fertilization techniques. A two-year experiment conducted in the Tselemty district during the off seasons of 2019 and 2020 aimed to assess the impact of varying irrigation levels and nitrogen fertilizer application rates on the growth, yield, and crop water productivity of pepper. The study included three irrigation levels (75%, 100%, and 125% of the required irrigation) and three nitrogen fertilizer application rates (75%, 100%, and 125% of the recommended amount). Analysis of the results using Gen-Stat software revealed that most pepper yield attributes were not significantly affected by the different irrigation and fertilizer levels. However, the marketable yield showed significant variation based on the combined application rates. The research indicates that, under ideal circumstances, the optimal approach for pepper growers is a combination of meeting 100% of the irrigation requirement and applying 100% of the recommended nitrogen fertilizer rate. Nevertheless, in scenarios where water resources are limited and fertilizer expenses are high, a reduced irrigation level of 75% of the requirement coupled with 75% of the recommended nitrogen fertilizer rate could be a viable alternative that does not lead to a substantial decrease in yield. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the levels of fluoride in drinking water and its health impact in Semema, Tigray, Ethiopia. Water samples were collected in February, March and April from three potential spring water sources, namely May Atkaru, May Sensela and May Liham. Each sample was analyzed for a variety of physicochemical parameters including fluoride using standard APHA procedures through double beam UV–Visible spectrophotometer, atomic absorption spectrophotometer and titrimetric methods. All the measured physicochemical parameters except hardness (345.78–368.35 mg/L) and alkalinity (231.3–354.6 mg/L) were recorded below the WHO permissible limit set for drinking water. The amount of fluoride in May Atkaru (4.00 mg/L) and May Sensela (3.89 mg/L) was significantly greater than the WHO permissible limit set for drinking water, 1.5 mg/L. Moreover, HQ . 1 from May Atkaru and May Sensela revealed the possibility of dental and skeletal fluorosis over extended exposure to fluoride irrespective of age and sex variations. This confirmed people in the area with mottled teeth are vulnerable to the excessive consumption of fluoride, which poses health risks. Therefore, it needs immediate interventions to minimize the debilitating effect of fluoride in drinking water by creating awareness among the community and policymakers to introduce low-cost defluoridation methods. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related kidney injury contributes to a high burden of acute kidney injury in low-resource settings and causes maternal and perinatal morbidity and mortality. Few studies have examined the impact of acute kidney injury in resource-limited countries, with very limited research on pregnancy-specific disorders in Ethiopia. This study aimed to determine the characteristics of pregnancy-related acute kidney injury, outcomes and associated factors. Methods: A retrospective study was conducted to evaluate the clinical profile and maternal-fetal outcome of pregnancy-related acute kidney injury at Ayder Comprehensive Specialized Hospital in Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Maternal and fetal outcomes were analyzed using descriptive statistics. Multivariate logistic regression was used to determine the association between the dependent and independent variables. Results: Of 27,350 mothers who delivered at Ayder Comprehensive Specialized Hospital between January 1, 2017, and December 31, 2021, a total of 187 women developed pregnancy-related acute kidney injury, a prevalence rate of 68 per 100,000 births. Preeclampsia, sepsis and pre-renal causes due to dehydration and hemorrhage were the most common causes of pregnancy-related acute kidney injury in this study. Hemodialysis was needed in 8.6% (n = 16) of patients. Of the 187 pregnancy-related acute kidney injuries, 143 (76.5%) recovered completely and 30 (16%) partially. The mortality rate was 7.5%. Preexisting chronic kidney disease (AOR = 30.13; 95% CI: 2.92, 310.84), use of vasoactive agents (AOR = 5.77; 95% CI: 1.47, 22.67), increase in creatinine per unit (AOR = 1.65; 95% CI: 1.11, 2.45) and complications related to acute kidney injury (AOR = 5.26; 95% CI: 1.73, 16.00) were determinants of the composite endpoints (partial renal recovery and death). Conclusions: This study emphasizes acute kidney injury in resource-limited settings is a significant cause of maternal and fetal morbidity and mortality. The vast majority of patients with pregnancy-related acute kidney injury recovered completely from kidney injury. The main causes of pregnancy-related acute kidney injury were preeclampsia, sepsis and pre-renal associated with hemorrhage and dehydration. Preexisting renal disease, use of vasopressors, increase in creatinine per unit and complications associated with acute kidney injury were determining factors for concomitant fetomaternal mortality. Appropriate preventive strategies during prenatal care and prompt treatment are needed for pregnancy-related acute kidney injury. [ABSTRACT FROM AUTHOR]

Background: Although antiseizure medications play a crucial role in the management of epilepsy, their benefit can be compromised due to drug-related problems. Drug therapy problems can lead to poor seizure control, reduced quality of life, and increased morbidity and mortality in patients with epilepsy. However, in our setting, there is limited knowledge about drug therapy problems and the factors that contribute to them. Objective: The aim of this study was to investigate the prevalence and contributing factors of drug-therapy problems among patients with epilepsy. Methodology: A hospital-based prospective observational study was conducted at the neurologic clinic of Ayder Comprehensive Specialized Hospital, located in the Tigray region of Northern Ethiopia. The study included adult patients diagnosed with epilepsy who had been taking at least one antiseizure medication for a minimum of six months. Data were collected by conducting patient interviews and expert reviews of medical and medication records. Prior to data review and interviews, each patient provided written informed consent. Drug therapy problems were identified and classified using Cipolle's method, followed by a consensus review conducted with a panel of experts. Statistical analysis was performed using a statistical software package; SPSS version 22. Binary logistic regression analysis was conducted to determine the contributing factors of drug therapy problems. Statistical significance was determined at p<0.05. Results: A study conducted on 250 participants revealed that 55.2% of the patients experienced one or more drug therapy problems. Our analysis identified a total of 282 drug therapy problems, with a mean of 2±0.52 drug therapy problems per patient. The most commonly observed drug therapy problems were dosage too low (30.0%), noncompliance (22%), adverse drug reaction (18%), and unnecessary drug therapy (16.4%). The commonly involved antiseizure medications in these drug therapy problems were phenytoin (22.8%), Valproic acid (20.8%), and Phenobarbital (18.4%). Furthermore, our findings revealed that combination therapy (AOR: 3.92, 95%CI: 1.19–12.97) and uncontrolled seizure (AOR: 108.37, 95%CI: 38.7–303.6) exhibited significant associations with drug therapy problems. Conclusion: Drug therapy problems were prevalent among patients with epilepsy. The use of combination therapy and the presence of uncontrolled seizures were identified as significant indicators of drug therapy problems. Therefore, more emphasis should be given to patients with multiple medications and uncontrolled seizures. [ABSTRACT FROM AUTHOR]

Background: Maternal sepsis is the third leading cause of maternal death in the world. Women in resource-limited countries shoulder most of the burdens related to sepsis. Despite the growing risk associated with maternal sepsis, there are limited studies that have tried to assess the impact of maternal sepsis in resource-limited countries. The current study determined the outcomes of maternal sepsis and factors associated with having poor maternal outcomes. Methods: A facility-based retrospective cross-sectional study design was employed to assess the clinical presentation, maternal outcomes, and factors associated with maternal sepsis. The study was conducted in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Sociodemographic characteristics, clinical characteristics and outcomes of women with maternal sepsis were analyzed using a descriptive statistic. The association between dependent and independent variables was determined using multivariate logistic regression. Results: Among 27,350 live births, 298 mothers developed sepsis, giving a rate of 109 maternal sepsis for every 10,000 live births. There were 22 maternal deaths, giving rise to a case fatality rate of 7.4% and a maternal mortality ratio of 75 per 100,000 live births. Admission to the intensive care unit and use of mechanical ventilator were observed in 23.5% and 14.1% of the study participants, respectively. A fourth (24.2%) of the mothers were complicated with septic shock. Overall, 24.2% of women with maternal sepsis had severe maternal outcomes (SMO). Prolonged hospital stay, having parity of two and above, having the lung as the focus of infection, switchof antibiotics, and developing septic shock were significantly associated with SMO. Conclusions: This study revealed that maternal sepsis continues to cause significant morbidity and mortality in resource-limited settings; with a significant number of women experiencing death, intensive care unit admission, and intubation attributable to sepsis. The unavailability of recommended diagnostic modalities and management options has led to the grave outcomes observed in this study. To ward off the effects of infection during pregnancy, labor and postpartum period and to prevent progression to sepsis and septic shock in low-income countries, we recommend that concerted and meticulous efforts should be applied to build the diagnostic capacity of health facilities, to have effective infection prevention and control practice, and to avail recommended diagnostic and management options. [ABSTRACT FROM AUTHOR]

Background: Food insecurity is a state or condition in which people have limited or uncertain physical, social, and economic access to safe, sufficient, and nutritious food to meet their dietary needs. Since no thorough evaluation was carried out to determine the degree of household food insecurity in Tigrayan communities in the aftermath of the conflict. This study aims to describe household-level food insecurity status among pregnant and lactating women during the post-armed conflict in Tigray, Ethiopia. Method: Descriptive research was designed to assess household food insecurity. A multi-stage sampling technique was used for this study. One thousand two hundred forty-nine households were selected systematically following a list of food insecure households. Descriptive statistical values, including frequency counts, percentages, minimum values, maximum values, and averages, were calculated to quantify the indicators under study. Household food insecurity and hunger Scale measurement using the standardized Food and Agriculture Organization standard. Results: The mean age (± SD) of the mothers was 28.35 ± 5.91 years. More than three fourth of the participants 1010(80.93%) were rural residents. The survey result showed that 88.8% of the pregnant and lactating were food insecure. Half (50.1%) of the households were hungry,one month before the study, 78.5% of the families expressed concern about running out of food and 6.4% had severe hunger. Conclusions: The food insecurity levels and hunger prestige of the study communities were excessively high. This is in the context of a region affected by intense armed conflict. It is commended that the study communities need to be safeguarded from the direct and long-term consequences of armed conflict-caused household food insecurity. [ABSTRACT FROM AUTHOR]

Background: Infective endocarditis (IE) is a continuously evolving disease with a high mortality rate despite different advances in treatment. In Ethiopia, there is a paucity of data regarding IE. Therefore, this study is aimed at assessing IE-related in-hospital mortality and characterization of IE patients based on their microbiological, clinical features, and management profiles in the Ayder Comprehensive Specified Hospital (ACSH). Methods: We conducted a hospital-based prospective follow-up study with all consecutive sampling techniques for suspected infective endocarditis patients admitted to ACSH from January 2020 to February 2022. Echocardiography was performed, and three sets of blood samples for blood culture were taken as per the standard protocol. We also performed isolation of microbial etiologies and antimicrobial susceptibility tests. The data was analyzed using STATA version 16. Stepwise logistic regression was run to identify predictors of in-hospital mortality. Effects were measured through the odds ratio at the 5% level of significance. Results: Seventy-four cases of suspected infective endocarditis were investigated; of these, 54 episodes fulfilled modified Duke's criteria. Rheumatic heart disease (RHD) (85.2%) was the most common underlying heart disease. Murmur (94.4%), fever (68.5%), and pallor (57.4%) were the most common clinical findings. Vegetation was present in 96.3% of episodes. Blood culture was positive only in 7 (13%) episodes. Complications occurred in 41 (75.9%) cases, with congestive heart failure being the most common. All patients were managed medically, with no surgical intervention. The in-hospital mortality was 14 (25.9%). IE-related in-hospital mortality was significantly associated with surgery recommendation and myalgia clinical symptoms. Conclusion: IE occurred relatively in a younger population, with RHD as the most common underlying heart disease. There was a high rate of culture-negative endocarditis, and the majority of patients were treated empirically. Mortality was high. The establishment of cardiac surgery and strengthening microbiology services should be given top priority. [ABSTRACT FROM AUTHOR]

Objective: This study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict. Design: Community‐based cross‐sectional study. Setting: Tigray region of Northern Ethiopia, between November 2020 and May 2022. Population: This study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas. Methods: The study was conducted in two phases. In the first phase, reproductive‐age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households. Main Outcome Measures: Maternal mortality ratio level and cause‐specific mortality. Results: The results of the study showed that the maternal mortality ratio was 840 (95% CI 739–914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy‐induced hypertension, 21 (8.4%), and accidents, 14 (5.6%), were the main causes of mortality. Additionally, 203 (81.2%) of the mothers died outside of a health facility. Conclusions: This study has shown a higher maternal mortality ratio following the dynamics of the Tigray war, as compared with the pre‐war level of 186/100 000. Furthermore, potentially many of the pregnancy‐related deaths could have been prevented with access to preventive and emergency services. Given the destruction and looting of many facilities, the restoration and improvement of the Tigray health system must take precedence. [ABSTRACT FROM AUTHOR]

Background: More than 70% of the health facilities in Tigray, northern Ethiopia, have been totally or partially destroyed by the recent war in the region. Diagnosis and management of tuberculosis were among many health services that suffered. In this study we assess the status of tuberculosis care in health facilities of Tigray during the recent war and compare it with the immediate pre-war state. Methods: Using sequential mixed method, we analyzed and compared the availability of diagnostic services in 69 health facilities and the utilization of tuberculosis care in 50 of them immediately before the war (September-October 2020) and during the war (November-July 2021). TB focal persons in each selected health facility were interviewed to evaluate the status of diagnostic services. Patient service utilization was assessed using health facility registrations. We also compared the average monthly case detection rate of multidrug resistant tuberculosis in the region before and during the war. We computed summary statistics and performed comparisons using t-tests. Finally, existing challenges related to tuberculosis care in the region were explored via in-depth interviews. Two investigators openly coded and analyzed the qualitative data independently via thematic analysis. Results: Among the 69 health facilities randomly selected, the registers of 19 facilities were destroyed by the war; data from the remaining 50 facilities were included in the TB service utilization analysis. In the first month of the war (November 2021) the number of tuberculosis patients visiting health facilities fell 34%. Subsequently the visitation rate improved steadily, but not to pre-war rates. This reduction was significant in northwest, central and eastern zones. Tuberculosis care in rural areas was hit hardest. Prior to the war 60% of tuberculosis patients were served in rural clinics; this number dropped to an average of 17% during the war. Health facilities were systematically looted. Of the 69 institutions assessed, over 69% of the microscopes in health centers, 87.5% of the microscopes in primary hospitals, and 68% of the microscopes in general hospitals were stolen or damaged. Two GeneXpert nucleic acid amplification machines were also taken from general hospitals. Regarding drug resistant TB, the average number of multidrug resistant tuberculosis (MDR TB) cases detected per month was reduced by 41% during the war with p-value < 0.001. In-depth interviews with eight health care workers indicated that the main factors affecting tuberculosis care in the area were lack of security, health facility destruction, theft of essential equipment, and drug supply disruption. Conclusion and recommendation: Many tuberculosis patients failed to visit health facilities during the war. There was substantial physical damage to health care facilities and systematic looting of diagnostic equipment. Restoring basic public services and revitalizing clinical care for tuberculosis need urgent consideration. [ABSTRACT FROM AUTHOR]

Background and Aims: Undiagnosed hypertension is a major risk factor for cardiovascular diseases and complications such as heart attack and stroke. Limited information is available on the prevalence of undiagnosed hypertension and its associated factors in Ethiopia, particularly in the study setting. This study aimed to assess the prevalence of undiagnosed hypertension and its associated factors in the central zone of Tigray, Northern Ethiopia. Methods: A community‐based cross‐sectional study was conducted from April 1 to May 31, 2020. A pretested structured questionnaire was used and both face‐to‐face interview and physical measurement were used to collect the data. Blood pressure was measured on two different days for each study participant, and an average of the measurements were taken. In addition, 736 participants were included in this study, through a systematic random sampling technique. Data were analyzed using SPSS version 23. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with undiagnosed hypertension. Adjusted odds ratios and 95% confidence intervals were used to show the strength of the association and declare statistical significance at p < 0.05. Results: In the study, the mean age of the participants was 51.9 (standard deviation: 17.9) years old. Prevalence of undiagnosed hypertension was found 15.4% (N = 113). The factors associated with undiagnosed hypertension were being divorced (adjusted odds ratio [AOR] = 15.2, 95% confidence interval [CI]: 8.2–28.3), alcohol consumption (AOR = 2.07, 95% CI: 1.22–3.51), not eating fruits (AOR = 4.1, 95% CI: 2.37–7.08), not eating vegetables (AOR = 3.47, 95% CI: 2.02–5.96) and poor knowledge (AOR = 3.05, 95% CI: 2.75–7.83). Conclusion: Around one in six study participants had undiagnosed hypertension. Being divorced, drinking alcohol, not eating fruits, not consuming vegetables, and having poor knowledge of hypertension were significant factors. Public health interventions, like providing adequate hypertension health information, frequent screening, and implementation of an appropriate intervention for particular factors, are critical for reducing the burden of undiagnosed hypertension. [ABSTRACT FROM AUTHOR]

Background: Higher rate of acute malnutrition is observed in emergencies compared to non-emergency settings and severe acute malnutrition upsurges alarmingly and become deadly in humanitarian crises due to lack of food, lack of quality water supply and insufficient healthcare. Research is one learning tool by identifying strength and areas of improvement. However, little is known about outcomes of therapeutic feeding programmes in comparison with the standard indicators set in humanitarian setting. Methods: Health facility based prospective cohort study was conducted using routinely collected programme data of children hospitalized to the inpatient therapeutic feeding center in suhul general hospital from January 1st, 2023 to June 30, 2023. Data was collected using a form developed relating to the federal ministry of health standard management protocols for severe acute malnutrition then it was cleaned, coded and entered to EpiData version 4.2.0 and then exported to SPSS version 25 for analysis. Results: From 184 children, 96.2% were stabilized while the remaining 3.8% were censored with overall median stabilizing time of 8 days. Weight gain was used as one of the discharging criteria for infants less than six months and their mean weight gain found to be 12.89 g per kilogram daily. Appetite test (AHR = 0.338; 95% CI: 0.221–0.518), blood transfusion (AHR = 5.825; 95% CI: 2.568–13.211), IV fluid resuscitation (AHR = 2.017; 95% CI: 1.094–3.717), IV antibiotics (AHR = 2.288; 95% CI: 1.164-4.500) and NG tube feeding (AHR = 1.485; 95% CI: 1.065–2.071) were identified as significant predictors of stabilizing time. Conclusion: All the outcome indicators for stabilization center are consistent with the SPHERE association set of standards during humanitarian intervention. The hospital and other concerned humanitarian organizations should focus on sustaining these achievements as suhul hospital is the main treatment center for children suffering from severe acute malnutrition in the northwest zone of Tigray regional state. Further pre-post experimental studies which compare the stabilizing time before and after crisis are recommended. [ABSTRACT FROM AUTHOR]

Background: In resource-limited countries with weak healthcare systems, women of reproductive age are particularly vulnerable during times of conflict. In Tigray, Ethiopia, where a war broke out on 04 November 2020, there is a lack of information on causes of death (CoD) among women of reproductive age. This study aims to determine the underlying CoD among women of reproductive age during the armed conflict in Tigray. Methods: This community-based survey was carried out in six Tigray zones, excluding the western zone for security reasons. We used a multistage stratified cluster sampling method to select the smallest administrative unit known as Tabiya. Data were collected using a standardized 2022 WHO Verbal Autopsy (VA) tool. The collected data were analyzed using the InterVA model using R analytic software. The study reported both group-based and cause-specific mortality fractions. Results: A total of 189,087 households were screened and 832 deaths were identified among women of reproductive age. The Global Burden of Disease classification showed that infectious and maternal disorders were the leading CoD, accounting for 42.9% of all deaths. External causes contributed to 26.4% of fatalities, where assault accounted for 13.2% of the deaths. Maternal deaths made up 30.0% of the overall mortality rate. HIV/AIDS was the primary CoD, responsible for 13.2% of all deaths and 54.0% of infectious causes. Other significant causes included obstetric hemorrhage (11.7%) and other and unspecified cardiac disease (6.6%). Conclusions: The high proportion of infectious diseases related CoD, including HIV/AIDS, as well as the occurrence of uncommon external CoD among women, such as assault, and a high proportion of maternal deaths are likely the result of the impact of war in the region. This highlights the urgent need for targeted interventions to address these issues and prioritize sexual and reproductive health as well as maternal health in Tigray. [ABSTRACT FROM AUTHOR]

Continuous adoption of improved maize varieties in the last three decades has changed farm landscapes from heterogeneity to maize homogeneity in semiarid areas of Ethiopia. This has substantially decreased maize productivity. Recently, farmers have integrated faba bean into maize-based farming systems aimed at increasing productivity. Yet, there is limited information on the effects of maize-faba bean intercropping on productivity and land-use efficiency. We studied the effects of maize intercrops with two faba bean varieties (Gora and Moti) at three different densities (25, 50, and 75%) of the recommended sole faba bean (250,000 plants ha−1) on yield, economic return, and some soil fertility indicators in Tigray, northern Ethiopia. Randomized complete block design with three replications was used for the experiment. The intercrops revealed that a significantly higher total grain yield, economic revenue, and land equivalent ratio (LER) over the sole cropping. Intercrops also showed higher soil organic carbon and total nitrogen compared to the preplanting soil and sole maize. Maize intercropped with the Gora faba bean variety at a density of 50% increased the total grain yields, economic return, and LER, respectively, by 13, 42, and 38% over the sole maize. The intercrop also increased soil total N by 55 and 22% compared to the preplanting soil and sole maize, respectively. Intercropping maize with faba bean significantly improved crop yield, income, land-use productivity, and some soil fertility indicators than either the sole maize or faba bean crop in the semiarid region of northern Ethiopia. [ABSTRACT FROM AUTHOR]

Smallholder farmers in Tigray have been growing Rhamnus prinoides trees/shrubs with annual crops in rain-fed farmlands. Although this agroforestry system is widely practiced, there are no sufficient scientific reports on its profitability and financial returns. The objective of this research was to analyze the financial profitability and relative financial advantages of R. prinoid-based agroforestry compared to monocropping practices, in eastern Tigray. Data were collected using a structured questionnaire from 123 randomly selected households who practiced R. prinoides-based agroforestry. To address the objective, we estimated the net present values (NPV), Annuity values, and benefit to cost ratio (BCR) on per hectare basis. The annuity and BCR of agroforestry were compared with those of adjacent monoculture farms of the associated crop components in agroforestry. The land equivalent ratios (LER) of the agroforestry were calculated and compared with sole crops. The NPV and BCR of the agroforestry were 5.6 and nearly fourfold higher than that of the monocropping, respectively. Similarly, the R. prinoides-based agroforestry LER was 0.33–1.36% higher as compared to monocultures. Stocking density and age of agroforestry affected the financial return from R. prinoides-based agroforestry. We concluded that R. prinoides-based agroforestry has superior financial performance over monocrops and is financially less risky. Therefore, the adoption of R. prinoides-based agroforestry practices is a viable option for smallholder farmers to maximize net returns from their rain-fed farmlands and resource inputs. [ABSTRACT FROM AUTHOR]

Apart from the inequality in vaccination, war zones and areas where communication is disrupted are affected by myths and misconceptions about COVID-19 vaccines, heightening vaccine hesitancy. Local data on adverse events of the vaccines and their mildness can increase confidence and acceptance of the vaccines in the respective population. In areas of conflict and communication blackouts, the perception of the vaccines by health workers is of paramount importance as public health recommendations may not reach the public. Therefore, the scientific evaluation of adverse events following COVID-19 vaccination in such areas is invaluable. This cross-sectional, facility-based study was conducted using a structured, interviewer-administered questionnaire to assess the adverse events experienced by healthcare workers who received the Janssen COVID-19 vaccine. The sample was divided proportionally to the number of vaccinated healthcare workers for the different healthcare professions, and participants were then randomly selected from each profession. Prior to data collection, a pilot test was conducted with 5% of the sample size outside the selected hospital. The study was conducted using a structured questionnaire completed by an interviewer to assess adverse events in 442 healthcare workers who had received the Janssen COVID-19 vaccine between July 11 and 25, 2022. The study period was from August 15 to September 15, 2022. A significant number of healthcare workers [366 (83.3%); 95% CI 79.5%, 86.5%] experienced at least one adverse event. Nearly 90% of participants reported that the adverse events were mild to moderate. Pain at the injection site [307 (69.5%); 95% CI 65.0%, 73.6%] and headache [247 (55.9%); 95% CI 51.2%, 60.4%] were the most common local and systemic adverse events, respectively. Two HCWs experienced anaphylactic reaction. Younger age was significantly associated with the occurrence of adverse events. We deciphered that the adverse events reported by the study participants were not different from the typically occurring vaccine-related adverse reactions, and therefore concluded that post-vaccination reactions in healthcare workers were minor. Although vaccination in Tigray is currently stalled due to the siege, responsible stakeholders should develop a mechanism to track population-wide adverse events once the vaccines start to rollout. [ABSTRACT FROM AUTHOR]

Background: Displacement is a psychologically stressful event. Since the war began, the people of Tigray were subjected to stressful events such as torture, rape, the killing of a family member, forced displacement, and even ethnic cleansing in their home countries. Especially displaced individuals are faced mental health problems. This study aimed to assess the prevalence of depression and associated factors among community internally displaced people due to the war on Tigray, in 2021. Methods: The community-based cross-sectional study design was applied from August 06 to 30, 2021 in all Weredas of Tigray. A total of 1,990 cIDP were recruited through a two-stage sampling technique. A structured and standardized questionnaire was used to collect data. Both bivariate and multivariable logistic regression was applied to identify associated risk factors and AOR with 95% confidence interval was used to select statistically significant variables. Results: The prevalence of depression among internally displaced people was 81.2% (95% CI: 79.4–83%), with more than 60% categorized as moderate and severe depression. The married and divorced marital status, being government employee, having family size > = 4, destruction of household fixed assets, looting of cereals, and having disabled family members due to the war were the significantly associated risk factors of depression. Conclusions: The prevalence of depression among community internally displaced people during the war on Tigray is very high compared to other studies conducted elsewhere. Almost 8 of 10 IDPs are developed depression and this is a very series health issue that needs immediate intervention by local, international organizations and communities around the world. [ABSTRACT FROM AUTHOR]

The growing needs for agricultural production require maintaining and improving soil fertility through fertilization. However, most research to date in Ethiopia particularly in the Tigray regional state has focused on the effects of soil chemical properties and relatively little work has been done on soil physical properties. The objective of this study was to assess the effects of compost, blended (NPSZn), and potassium chloride (KCl) fertilizers on soil bulk density (BD) and moisture content (SMC). Therefore, a field experiment was carried out for 2018-2019 years to study the influence of sole and combined application of compost, NPSZn, and KCl fertilizers on BD and SMC in clay loam and loamy sand soil textures in Tigray. Two compost (0 and 20 t·ha−1), three NPSZn (0, 60, and 120 kg·ha−1), and four KCl (0, 120, 210, and 300 kg·ha−1) rates replicated three times were arranged in split-split plot design and allocated to main, sub, and sub-subplots, respectively. BD (g·cm−3) and SMC (%) data were collected from 0 to 10 and 0 to 30 cm soil depths before and after harvesting in 2018 and 2019, respectively. Sole and combined application of the fertilizers considerably influenced BD and SMC in both soil textural groups and years. Compost applied in combination with NPSZn at 120 kg·ha−1 and KCl at 300 kg·ha−1 significantly reduced BD (1.24 g·cm−3 in 2018 and 1.22 g·cm−3 in 2019) in clay loam soils as compared to all treatments. Similarly, the lowest BD (1.5 g·cm−3 in 2018 and 1.47 g·cm−3 in 2019) was observed in loamy sand soils. The highest volumetric SMC (21% in both years) was observed in clay loam soil in plots treated with compost. Likewise, the highest SMC (12% in 2018 and 11% in 2019) was found in loamy sand soils in compost-treated plots. This study demonstrated that SMC and BD can be improved through compost and compost combined with NPSZn and KCl application, respectively, in the drylands of Northern Ethiopia. [ABSTRACT FROM AUTHOR]

Globally, war is the major cause of displacement from the usual place of the biological environment. The war of Tigray exposed thousands of people to internal displacement and migration. Evidence has shown that displaced people and migrants shoulder the health and economic burden to ensure survival. However, evidence of the impact of the war on health and the economy related to the displaced people and their hosting communities is not documented. Thus, this study aimed to investigate the health and economic impact of the war on displaced people and the hosting community. A community-based survey was conducted among randomly selected 3572 households of 48 woredas/districts from August 06 to 30/2021 in Tigray. Each district had 4 enumeration sites and there were 20 households (HHs) to be sampled per each enumeration site. Data were collected using a pretested structured questionnaire using face-to-face interviews of displaced and hosting household heads. The entered data is exported to SPSS version 26 statistical packages for data analysis. Summary statistics and geo-spatial analysis was computed. The war had a significant impact on the health and economy of the community of Internally Displaced People (cIDPs) and hosting households. There were 12,691 cIDPs and 3572 hosting HHs. About 12.3% had chronic illness12.3% of (cIDP) who had chronic diseases and follow-up medication was forced to stop their medication. 536 (15%) civilian family members of cIDPs were killed at their homes. During the war, 244 (6.83%) of civilian family members faced physical disability. Consequentially, 43.8% and 58.8% of respondents of cIDPs suffered from severe depression and post-traumatic stress disorder. The war had a significant amount of personal resources such as domestic animals, cereals, cars, machinery, and HH furniture was looted and vandalized by the perpetrator forces from the cIDPs and hosting HHs. The range of family size in the hosting households was 3 to 22. The war had a significant health and economic impact on both cIDPs and hosting HHs. cIDPs suffered from various illnesses and disabilities related to the war with no medical access and follow-up care leading them to stressful situations such as depression and PTSD. There was also a huge economic damage and distraction which threatens the survival of the survivors. [ABSTRACT FROM AUTHOR]

The survey was conducted before the ignition of the war in Tigray Regional State, Ethiopia (before October 2020). The objective of the survey was to characterize the husbandry practices of three indigenous sheep populations. A total of 253 sample households were randomly involved in the face-to-face interview. The Statistical Package for Social Sciences software was used for data analysis. Illiterates (34 %) and 44 % of the respondents attended lower primary school. A mean (± SD) flock size of 7.91 ± 11.4 Tropical Livestock Unit (TLU) of indigenous sheep of the three genotypes were kept under extensive husbandry practices, however, the indigenous sheep population trend was at a decreasing state (55 %) in the last ten years. There was lower mean flock size in Arado (11.72 ± 8.0) than in Begait (85.07 ± 90.1) and Rutanna (223.08 ± 170.5) sheep. The decreasing state of communal grazing area (97 %) resulted in seasonal feed scarcity (96 %) in the last five years. Hence, feed supplementation was practiced in 74 % of the respondents done in the dry season. Animals of most respondents (71 %) went to water source to drink water. It was noted that most animals drank water once a day (63 %) in the dry season. It was also noted that sheep fattening (4 %) was a neglected activity. There were sheep production challenges (100 %) and opportunities (72 %). Diseases (86 %) and external parasites (80 %) were major constraints in sheep production. However, lack of veterinary service (78 % no service) centre was a critical challenge. Practices of own ram-ewe mating (68 %), own flock born rams (51 %), uncontrolled mating (66 %), pure breeding (86 %) and use of rams outside of their flocks (79 %) were practiced in the indigenous sheep populations. Unknown ram-to-ewe ratio (26.9 %) and a ratio of one-ram-to-all-ewes in a flock (29.6 %) were practiced. Ram castration (35 %) was practiced to improve carcass quality (32 %). Feed development, shift to modern husbandry practices, access to veterinary services, indigenous sheep conservation through utilization, control of inbreeding, ram-to-ewe ratio, fattening and castration should be of future attentions of farmers and stakeholders. [ABSTRACT FROM AUTHOR]

To determine the effect of armed conflict and COVID-19 pandemic on the level and trend of surgical volume at Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia.Methods: All major surgeries carried out over four consecutive years were included and subjected to an interrupted time-series analysis called segmented regression analysis to examine the effect of war and COVID-19 on level of and trend changes in major surgeries. The outcome was measured and estimated that there was a significant change in the number of major surgeries as a result of the conflict and COVID-19 pandemic compared to the baseline status.Results: We analyzed 29,877 major surgeries conducted during the study period. The results indicate that, before the beginning of the intervention period, on average 632 surgeries per month were performed [632.1 (95% CI: 575.8, 688.41)]. Right after COVID-19, however, this number dropped by 359 patients per month [− 359.3 (95% CI: − 486.4, − 232.2)]. During the war period, the number of surgeries decreased by 232 patients per month [− 232.7 (95% CI: − 408.5, − 56.9)].Conclusion: This study revealed that both COVID-19 and the war in Tigray have significantly reduced the number of major surgeries that could have been carried out in their absence at a large tertiary hospital in Northern Ethiopia. [ABSTRACT FROM AUTHOR]

Mastitis is the most common disease of adult dairy cattle. The disease continues to be one of the most perplexing and costly diseases of dairy cattle. The present study was conducted to detect bovine mastitis cows and identify potential risk factors for the distribution of bovine mastitis of smallholder dairy farmers using the California mastitis test. A cross-sectional study was conducted from September 2013 to May 2015 in the southern zone of Tigray, Northern Ethiopia, on 146 head of randomly selected cattle, of which 99 (67.8%) were crossed zebu and 47 (32.2%) pure local zebu using the California mastitis test and questionnaire. The overall prevalence was 65 (45.5%), of which 72.3% of crossed local and 27.69% of local zebu were found positive for the CMT test. The investigated risk factors were the season of lactation (OR = 0.510, CI = 0.208–1.247, P = 0.140), washing hands between consecutive milking events (OR = 0.354, CI = 0.146–0.856, P = 0.021), and history of previous mastitis (OR = 0.441, CI = 0.226–0.858, P = 0.016), which had significant (P < 0.05) effect on the present prevalence of bovine mastitis in the study area. A high prevalence of bovine mastitis was observed in the southern zone of Tigray. The summer season of lactation and not washing hands between consecutive milking of cows were significant mastitis causation risk factors in addition to the history of previous mastitis disease history. [ABSTRACT FROM AUTHOR]

Herbaceous species contribute to the largest proportion of the fodder. Despite the profound benefits obtained, anthropogenic disturbances are hindering its development. On the other hand, to ensure the sustainability of herbaceous species, communities and governments have been putting efforts in managing herbaceous species through the establishment of area exclosure (AE). Thus, the main importance of this research paper is to provide information about the role of AE on the restoration of herbaceous species. The objective of this study was to assess the effect of restoration on the herbaceous species following AE established on communal grazing land (CGL). A total of 124 and 73 quadrats of 1×1m2 size were laid down at 50 m intervals along parallel transects at AE and CGL, respectively, and data were analyzed by t-test unequal variances using R-software. AE displayed higher plant species richness and diversity than the CGL and showed a significant difference (p<0.001). Similarly, the AE had significantly (p< 0.001) higher forage biomass than the CGL. In general, herbaceous species diversity index and species richness were significantly (p< 0.001) higher in the AE compared to the CGL. The study concluded that effective AE has the potential to enhance the restoration of herbaceous species and hence forage productivity. [ABSTRACT FROM AUTHOR]

Background: The care given for the first hours, days, and weeks after childbirth is life-threatening. So far, this period receives less attention from health-care providers than the care given to pregnancy and delivery. This study aimed to determine the prevalence and associated factors of early postnatal care service use among mothers who had given birth in the last 12 months in Adigrat Town, Tigray, Ethiopia. Methods: A community-based cross-sectional study was conducted from March to April 2018 among 481mothers who had given birth in the last 12 months. A systematic random sampling technique was used to select study participants. A pre-tested and structured questionnaire was used to collect the data. Data analysis was computed using SPSS version 20. An adjusted odds ratio with a 95% confidence interval and p-value less than 0.05 was used to determine the level of significance. Results: The proportion of early postnatal care service utilization was 34.3% (95% CI: 29.9%– 38.5%). Mothers' use of early postnatal care service was predicted by previous early postnatal care use (AOR=2.60, 95% CI: 1.41– 4.77), ANC visit (AOR=0.122, 95% CI:0.059– 0.251), delivery complication (AOR=5.57, 95% CI: 2.85– 10.89), distance (AOR =5.05, 95% CI: 2.45– 10.42), postnatal home visit (AOR=0.21, 95% CI: 0.11– 0.40), awareness on early postnatal care (AOR=16.38 95% CI: 6.23– 43.07), age (AOR=9.34, 95% CI: 1.73– 50.27), (AOR=6.50, 95% CI: 2.29– 18.41), (AOR= 6.23, 95% CI: 2.38– 16.33) and income (AOR=7.97 95% CI: 2.42– 26.26, AOR=3.30 95% CI:1.42– 7.67). Conclusion: Our study's finding revealed that the prevalence of early postnatal care service use was low. Early postnatal care service use was significantly associated with previous early postnatal care use, delivery complication, distance, postnatal home visit, number of ANC visits, awareness on early postnatal care use, age, and income. [ABSTRACT FROM AUTHOR]

Background: Trachoma is a neglected tropical disease which is the leading infectious cause of blindness in the world. Trachoma is one of the major health problems in Tigray Region, Northern Ethiopia. However, knowledge, attitudes, and practices about trachoma are not yet studied in depth. The objective of the study was to assess knowledge, attitudes, and practices on trachoma and its associated factors among rural communities in two districts of Tigay Region, Northern Ethiopia.Methods: A cross-sectional study was conducted in two districts of Tigray Region, Northern Ethiopia, from May 7-24, 2017. Data were collected on paper based, were entered into Epi Info version 3.5.1, and then exported to SPSS version 21 for analysis. Logistic regression analysis was done to identify factors associated with knowledge, attitudes, and practices.Results: In this study, a total of 194 respondents were included. The overall level of good knowledge, attitudes, and practices on trachoma was 51%, 49.5%, and 35.6%, respectively. Having ever received health education was significantly associated with good knowledge (adjusted odds ratio (AOR) = 4.10; 95% confidence interval (CI): 1.91-8.79) and attitudes (AOR = 2.10; 95% CI: 1.02-4.25). Moreover, good knowledge was associated with good practices on trachoma prevention and control (AOR = 2.86; 95% CI: 1.46-5.62).Conclusion: Our study implies that areas with high burden of trachoma need to improve communities' knowledge, attitudes, and practices towards trachoma prevention and control in order to eliminate trachoma as a public health problem. Therefore, health education focused on SAFE strategy should be provided to increase knowledge and changing attitudes that contribute for good practices towards trachoma prevention and control among communities. [ABSTRACT FROM AUTHOR]

The Yohannes IV Palace, located in Mekelle, the present regional capital of Tigray, Ethiopia, was constructed in the 1880s supervised by the Italian craftsman Giacomo Naretti. This study aims to clarify its historical orientation by analyzing its location, planning, and building elements, by considering Naretti's contribution, the building's relationship with local masonry buildings, and the characteristics of the preceding Ethiopian palace quarters. Through the research activities, it becomes clear that the palace's locational characteristics are in common with the preceding Ethiopian palace sites, especially Gonder. Its planning methods are similar to that of the former residential site of Yohannes IV, which was constructed without foreign builders. Its basic building elements were derived from the former Tigray's church buildings. Although these results suggest that the palace was a local product of the Ethiopian emperor Yohannes IV, the contribution of Naretti was also evident in more detailed elements of the palace such as the use of elaborate materials, decorative wooden works, stone arches, plaster, and its symmetrical appearance. These design achievements were most likely realized through Naretti's observation of the local building techniques and the natural environment, and his training of the local craftsmen during his stay in Ethiopia from 1871. [ABSTRACT FROM AUTHOR]

Background: Anemia is a common complication of HIV/AIDS in children. There is lack of evidence on anemia prevalence among children living with HIV/AIDS on highly active antiretroviral therapy (HAART) in Tigray regional state, which the current study aimed to generate.Methods: An institution-based cross-sectional study was conducted on 241 children living with HIV/AIDS on HAART attending the antiretroviral therapy (ART) clinic of Mekelle hospital from November 2018-January 2019. Socio-demographic data were collected using a structured pretested questionnaire. Participants' hemoglobin level was utilized to determine the prevalence of anemia. WHO cut-off values for Hgb were used to categorise the severity of anemia. Microscopic examination was performed for morphological classification of anemia.Results: Among the participants, 7 % (n = 16) were anemic in this study. Of these, 56 %, 19 %, and 25 % had mild, moderate, and severe anemia, respectively. Morphologically, normocytic-normochromic anemia was found the most common type of anemia in this study.Conclusions: The prevalence of anemia among participants was low in this study. However, a considerable proportion of participants had severe anemia, requiring regular monitoring of anemia status in these patients for better clinical outcomes and quality of life improvements. [ABSTRACT FROM AUTHOR]

Agroforestry plays a significant role in climate change mitigation through improved sequestration and storage of carbon in farmlands. However, quantitative information on above and belowground carbon inputs in agroforestry systems practiced is limited in the drylands is limited. This study estimated biomass and soil carbon stocks of Rhamnus prinoides based agroforestry practices in Ahferom and Ganta-Afeshum districts of Tigray region. Inventory was conducted on farms with R. prinoides intercropping of varied density. Destructive method was used to develop allometric models for estimating above and belowground biomass carbon. Undisturbed and composite soil samples were taken from farms with and without R. prinoides plants (open). The model based on diameter at stump height (r = 0.91) and height (r = 0.83) presented good fit (0.86 < R2 < 0.93, P < 0.01) with lower mean predicted error (MPE) values for estimating the aboveground (AGB) and belowground (BGB) biomass. Compared to existing models our model produced lower MPE (− 0.05) in predicting observed R. prinoides AGB. Overall, 8.3 Mg ha−1 and 5.5 Mg ha−1 carbon stocks were found in AGB and BGB, respectively. The carbon stock in AGB and BGB increased as tree density increases. Soil organic carbon (SOC) stock in farms with R. prinoides intercropping (121.9 ± 29 Mg ha−1) significantly increased as density increased, and it was significantly higher than nearby open farms (93.2 ± 25.6 Mg ha−1) (P < 0.05). SOC stock was not significantly decreasing from upper to lower soil depth in farm plots with R. prinoides of varied density. While significantly decreased in the open farms (P < 0.05). R. prinoides annual leaves harvest increased as tree density increased. While annual production of associated crop Wheat decreased. Farm plots with medium tree density and with large size were optimal for carbon accumulation, R. prinoides leaves and crop production. The higher amount of carbon stock in farms with R. prinoides agroforestry compared to open farms indicates the possibility of increasing carbon stock in farming systems through scaling up similar practices. [ABSTRACT FROM AUTHOR]

aimanot,1 Mistire Wolde,2 Aster Tsegaye21Department of Medical Laboratory Science, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 2Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Gebre Teklu Email [email protected] Aster Tsegaye Email [email protected] Background: The adverse health effects of chronic gasoline exposure may be related to impairment of the hematopoietic system with bone marrow suppression, an increased risk of blood cell morphology abnormality and developing cancer. Objective: To assess the effect of gasoline exposure on hematological parameters among gas station workers in Mekelle City, Tigray Region, Northern Ethiopia. Methods: This cross-sectional study was carried out on 43 subjects (exposed group) and 77 subjects (unexposed group) with matched age and sex. Socio-demographic characteristics and duration of exposure data were collected using a structured questionnaire and an observation checklist. Sysmex XP-300 was used for hematological analysis and stained peripheral blood smear was examined for any abnormality. Data were entered and analyzed using SPSS version 23. Results: Of exposed individuals, 28/43 (65.1%) and 49/77 (63.6%) of controls were males. The average exposure time was 5.19± 4.38 years, with an average working hour of 11.74± 1.89 hours/day. The mean RBC count (1012/L), HCT (%), HGB (g/dl) and platelets count (109/L) of the exposed group were significantly lower (4.88± 0.573, 43.29± 3.71, 15.04± 1.33 and 248.95± 58.19) compared with controls (5.35± 0.533, 44.95± 3.10, 15.59± 1.26 and 292.45± 62.17) at p< 0.05, respectively. The MCH (pg) (30.48± 2.06 vs 29.52± 1.66) and MCHC (g/dl) (34.83± 0.988 vs 34.32± 0.927) were significantly higher in the exposed group compared with controls (p< 0.05). HCT, RBC, HGB and platelet counts were significantly decreased with increased years of exposure (p< 0.05). The peripheral blood film examination revealed basophilic stippling and macrocytosis in 9.3% of the exposed group. Conclusion: Long-term exposure to gasoline at gas stations affected RBC parameters and platelet count. A significant negative correlation was noted between duration of exposure and HGB, HCT and platelet count, warranting implementation of protective measures at gas stations. [ABSTRACT FROM AUTHOR]

Background: In many resource-poor settings, nutritional counselling is one of the key components of nutrition support programmes aiming to improve nutritional and health outcomes amongst people living with HIV. Counselling methods, contents and recommendations that are culturally appropriate, locally tailored and economically affordable are essential to ensure desired health and nutritional outcomes are achieved. However, there is little evidence showing the effectiveness of counselling in nutritional programmes in HIV care, and the extent to which counselling policies and guidelines are translated into practice and utilised by people with HIV suffering from undernutrition. This study aimed to explore these gaps in the Tigray region of Ethiopia.Methods and Participants: A qualitative study was conducted in Tigray region Ethiopia between May and August 2016. Forty-eight individual interviews were conducted with 20 undernourished adults living with HIV and 15 caregivers of children living with HIV enrolled in a nutritional programme in three hospitals, as well as 11 health providers, and 2 programme managers. Data analysis was undertaken using the Framework approach and guided by the socio-ecological model. Qualitative data analysis software (QSR NVivo 11) was used to assist data analysis. The study findings are presented using the consolidated criteria for the reporting of qualitative research (COREQ).Result: The study highlighted that nutritional counselling as a key element of the nutritional programme in HIV care varied in scope, content, and length. Whilst the findings clearly demonstrated the acceptability of the nutritional counselling for participants, a range of challenges hindered the application of counselling recommendations in participants' everyday lives. Identified challenges included the lack of comprehensiveness of the counselling in terms of providing advice about the nutritional support and dietary practice, participants' poor understanding of multiple issues related to nutrition counselling and the nutrition programme, lack of consistency in the content, duration and mode of delivery of nutritional counselling, inadequate refresher training for providers and the absence of socioeconomic considerations in nutritional programme planning and implementation. Evidence from this study suggests that counselling in nutritional programmes in HIV care was not adequately structured and lacked a holistic and comprehensive approach.Conclusion: Nutritional counselling provided to people living with HIV lacks comprehensiveness, consistency and varies in scope, content and duration. To achieve programme goal of improved nutritional status, counselling guidelines and practices should be structured in a way that takes a holistic view of patient's life and considers cultural and socioeconomic situations. Additionally, capacity development of nutritional counsellors and health providers is highly recommended to ensure counselling provides assistance to improve the nutritional well-being of people living with HIV. [ABSTRACT FROM AUTHOR]

Background: Although, the clinical and socioeconomic condition of Tigray Regional State mothers has been improved along with the decline in the child death rate. However, children's death rate is still one of the main community serious challenging issues of public health concern. Thus, the main objective of this current investigation was to identify the major predictor factors for short time-to-death in Children in the Tigray Regional State.Methods: The study used a secondary data with cross-sectional study design. The information gathered was from 1018 childbirths 5 years prior to the survey. Independent variables such as mother's demographic variables, child demographic variables, healthiness and environmental factors were considered major hazard predictors of children's short time-to-death rate. This current investigation used bivariable and multivariable Cox regression model analysis to identify the major statistically significant associations with children's time-to-death rate.Results: One thousand eighteen children under 5 years of age were included in the study. Of them, 50% of the children were males, and the median survival time-to-death of children was 26 months. Overall, the prevalence of experiencing child's death rate in the Tigray Regional State was 4.2%. The multivariable Cox regression model analysis showed that living rural place of residence (AHR = 19.8; 95% CI: (7.25-54.049)), being unvaccinated child (no) (AHR = 2.76; 95% CI: (1.071-7.11)), and poor wealth index (AHR = 15.4; 95% CI: (2.83-84)) were statistically significant predictors of time-to-death rate of children's.Conclusion: The study recognized that being a rural place of residence, unvaccinated child status (no) and poor wealth index were statistically significant predictors of children's short time-to-death rate. [ABSTRACT FROM AUTHOR]

Therefore, we plan to study holistic ecology of geladas and human-gelada conflict to generate relevant information about the challenges of this endemic primate species. Population size, group composition and behavioral ecology of geladas (Theropithecus gelada) and human-gelada conflict in Wonchit Valley. Geladas ( I Theropithecus gelada i ) are a primate species endemic to Ethiopia and are the last remaining member of genus I Theropithecus i . I Theropithecus gelada gelada i the northern gelada, I Theropithecus gelada obscurus i the Southern gelada, and the new gelada taxon commonly called Arsi gelada (Gippoliti, 2010; Grubb, 2006; Mori & Belay, 1990; Shotake et al., 2016). [Extracted from the article]

Background: Overweight and obesity emerged as one of the most serious public health concerns in adolescents. Overweight and obesity are problems of not only high income but also low-middle income countries. Therefore, this study aimed to assess the magnitude and associated factors of overweight and obesity among public and private secondary school adolescents in Mekelle city, Tigray, Ethiopia, 2019. Materials and Methods: A school-based comparative cross-sectional study was conducted in Mekelle city, from April to May 2019. A multi-stage sampling technique was used to select 858 participants. Chi-square test was checked before bivariate logistic regression analyses. All variables at a p-value < 0.25 in bivariate logistic regression were entered into a multivariable logistic regression to determine the association between a set of independent variables with the dependent variable. Finally, statistical significance was declared at a p-value < 0.05. Results: The magnitude of overweight and obesity in private and public schools were 11.8% and 3.9%, respectively. Consuming dinner not daily [AOR=5.3:95% CI=1.93– 14.6] and working moderate-intensity sports at least 10 minutes/day continuously [AOR=0.19:95% CI=0.04– 0.9] were associated factors of overweight and obesity in public school adolescent students. Being female [AOR=2.03:95% CI=1.08– 3.8], time taken from home to public physical activities ≤ 15 minutes [AOR=3.6:95% CI=1.13– 11.51], using transport from school to home [AOR=2.2:95% CI=1.06– 4.18] and good knowledgeable adolescents [AOR=0.5:95% CI=0.27– 0.9] were associated factors of overweight and obesity in private schools. Conclusion: The magnitude of overweight and obesity was higher among private schools. Consuming dinner not daily and working moderate-intensity sports at least 10 minutes/day continuously were the associated factors for the occurrence of overweight and obesity in public school adolescent students. Being female, time taken from home to public physical activity facilities ≤ 15 minutes, using transport from school to home, and nutritional knowledge status of adolescents were associated factors for overweight and obesity in private school adolescent students. [ABSTRACT FROM AUTHOR]

Groundwater is one of the most important sources of drinking water in Kafta Humera Woreda; hence, it is important to assess the quality of these water sources. The aim of this study was to assess the levels of some physicochemical parameters and heavy metals in hand-dug well water sources of Kafta Humera Woreda. The results showed that the physicochemical concentrations of the hand-dug well water samples were given as follows: temperature, 27.67 ± 0.15 to 28.30 ± 0.25°C; pH, 6.90 ± 0.33 to 8.20 ± 0.36; dissolved oxygen, 5.60 ± 0.06 to 6.2 ± 0.04 mg/L; turbidity, 1.67 ± 0.02 to 1.89 ± 0.03 NTU; EC, 148.50 ± 0.89 to 932.00 ± 0.98 μS/cm; TDS, 105.80 ± 0.62 to 664.28 ± 0.70 mg/L; total hardness, 71.80 ± 3.05 to 295.30 ± 2.38 mg/L; total alkalinity, 75 ± 5.0 to 215 ± 5.0 mg/L; calcium, 12.02 ± 0.82 to 75.88 ± 0.93 mg/L; magnesium, 9.80 ± 0.80 to 25.70 ± 0.17 mg/L; potassium, 0.130 ± 0.003 to 0.86 ± 0.04 mg/L; sodium, 2.20 ± 0.16 to 12.75 ± 0.87 mg/L; chloride, 12.86 ± 0.02 to 42.72 ± 0.20 mg/L; sulfate, 17.24 ± 0.96 to 118.67 ± 0.46 mg/L; phosphate, 0.018 ± 0.005 to 0.020 ± 0.002 mg/L; and nitrate, 1.86 ± 0.03 to 5.43 ± 0.06 mg/L. Generally, the concentrations of most physicochemical parameters of the hand-dug well water samples of Kafta Humera Woreda were within the permissible limit of World Health Organization and Ethiopian Standard Agency guideline for drinking water. The statistical Pearson's correlation analysis on the water quality parameters revealed that all parameters are more or less correlated with each other. Electrical conductivity and total dissolved solids of the water samples were found to be significantly correlated with total hardness (r = 0.989), total alkalinity (r = 0.827), calcium (r = 0.988), magnesium (r = 0.881), sodium (r = 0.995), potassium(r = 0.996), chloride (r = 0.998), sulfate (r = 1), and nitrate ions (r = 0.972). Out of the selected seven heavy metals, Fe, Cu, Zn, Mn, Cr, Cd, and Pb, only iron was detected in all water samples and its concentration was above the permissible limit of WHO and ESA for drinking water. Therefore, the government should adopt some treatment technologies such as sedimentation and aeration to minimize the concentration of iron for safe drinking the water to the community of Kafta Humera Woreda. [ABSTRACT FROM AUTHOR]

Conservation agriculture (CA) systems represent a set of three soil management principles: minimarbance, permanent soil cover and crop rotations ‐ whereas the CA‐based systems in this study add the bed and furrow tillage techniques as integral elements of CA. Studies on the effects of long‐term CA‐based systems on soil health and crop productivity are rare globally, particularly in Ethiopia. This study aimed at investigating the long‐term (2005–2013) influence of CA‐based systems on soil health and crop productivity in northern Ethiopia. The treatments we used include two types of CA‐based systems (permanent raised bed PRB and contour furrowing CF) and conventional tillage (CT) arranged in a randomized complete block design. Soil samples were collected at 0–10 cm soil depth to assess soil health. Piecewise structural equation modeling (PSEM) was used to analyze linkages between management practices, soil health and crop productivity. Arbuscular mycorrhizal fungi spore abundance and root colonization was higher in PRB followed by CF compared to CT (p < 0.05). Significantly different soil N of 1.4 and 0.9 g kg−1 and available P of 6.7 and 4.1 ppm were recorded for PRB and CT, respectively. Higher straw and grain yield of 12 and 4.3, 10 and 3.5, 8 and 2.8 t ha−1 were recorded for PRB, CF and CT, respectively. Outputs of the PSEM highlighted two pathways in which CA‐based systems contributed to improved productivity: (a) via higher density of bacteria and improved hydraulic conductivity, and (b) via higher density of fungi and increase soil organic carbon content in the topsoil. The study concludes that CA‐based systems have the potential to improve crop productivity through improved soil health. [ABSTRACT FROM AUTHOR]

Breast cancer is a foremost cause of death worldwide, ranks fifth among causes of death from all types of cancers; this is the most common cause of cancer death in women among both developing and developed countries. Breast cancer ranks first among the most frequent cancers in women of Ethiopia. In spite of the high incidence, mortality rate, and survival status among breast cancer patients was not determined in Ethiopia. The purpose of this study was to identify factors affecting the time to death among breast cancer patients attending anti-cancer treatment from September 2015 till December 2018 at Ayder Comprehensive Specialized Hospital. Methods: Hospital-based retrospective cohort study was conducted among breast cancer patients. Kaplan-Meier survival curve together with log-rank test was deployed to test for variations in the survival among predictor variables. Cox regression was used at a 5% level of significance to determine the net effect of each independent variable on the time to death of breast cancer clients. Results: From the Cox proportional model, patients with age, educational status, residence, Baseline Tumor size &Pathology type (LIC) were found to be a statistically significant effect (p < 0.05) on the risk of mortality due to breast cancer and the median survival time of breast cancer patient was 34.50 months. Conclusion: the finding of this study showed that age, educational status, residence, Baseline Tumor size &Pathology type (LIC) were influential affecting time to death of breast cancer patient at the Hospital. It is recommended to make interventions based on these risk factors. [ABSTRACT FROM AUTHOR]

Abstract: Breast cancer is the major public health problem throughout the world and it results in serious physical damages and death. This work proposes the use of joint model to study breast cancer in patients of Ayder Hospital. The primary motivation is to contribute to the understanding of the tumor cell progression of breast cancer, within Ayder Hospital, using a joint model that takes into account a possible existence of a serial correlation structure within a same subject observations from September 2015 till December 2018. The general aim of this study was to investigate the risk of longitudinal change in tumor cell level on time to death due to breast cancer among breast cancer patients. Hospital-based retrospective cohort study was conducted among breast cancer patients. A joint model of longitudinal and time to death model was used to determine the risk of longitudinal change in tumor cell level on time to death due to breast cancer patients. These were used by using JM package in R version. Results from joint models, showed that the longitudinal Tumor cell progression was signicantly associated with the survival probability of these patients(estimated association parameter(ɑ) in the joint model is 0.84 with corresponding (95% CI: 2.28,2.37). A comparison between parameter estimates obtained in this joint model and independent survival and longitudinal analysis lead us to conclude that independent analysis brings up bias parameter estimates. There is a strong association between the progression change in log(TCL) and risk of mortality due to breast cancer. [ABSTRACT FROM AUTHOR]

Background: Ankle–foot pain is a significant public health problem in nurse professionals and has great burdens to the individuals, healthcare systems, and community at large. However, there is limited evidence on the prevalence of ankle–foot pain and its associated factors among nurses in Ethiopia. Thus, the finding of this study will help to address health problems resulting from ankle–foot pain among nurses. Purpose: The aim of this study was to determine the prevalence and associated factors of ankle–s–foot pain among nurse working in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia. Patients and Methods: An institutional-based cross-sectional study was conducted on a total of 366 nurses, and a simple random sampling technique was used to recruit study participants. Data were collected by using a self-administered adapted standardized Nordic questionnaire. Descriptive statistics and a bivariate logistic regression model were done to identify factors associated with ankle–foot pain. Those variables with a P-value less than 0.05 with 95% CI in multivariate model were taken as statistically significant. Finally, AOR with 95% confidence interval at a P-value of < 0.05 was reported. Results: The prevalence of self-reported ankle–foot pain among nurses was 43.7% (95% CI=38.5– 49.1). Older age (AOR=7.669, 95% CI=2.316− 25.390), low shoe comfort (AOR=4.215, 95% CI=2.031– 8.745), multiple foot conditions (AOR=6.102 95% CI=1.959– 19.008), working night shifts (AOR=2.047, 95% CI=1.098− 3.816), high physical demand (AOR=3.487, 95% CI=1.988– 6.116), and nurses working in the intensive care unit (AOR=2.402, 95% CI=1.219– 4.732) showed a statistically significant association with ankle–foot pain. Conclusion: This study indicated that the prevalence of ankle–foot pain is commonly reported among nurses working in Ayder Comprehensive Specialized Hospital. Therefore, awareness and prevention of ankle and foot pain in nurses should be prioritized to reducing risk factors. Nurses should give attention to comfortable footwear, and further longitudinal research is recommended. [ABSTRACT FROM AUTHOR]

Introduction: High prevalence of hepatitis B virus (HBV) infection among pregnant women is the primary source of infection for their children and the general population. Mother-to-child transmission (MTCT) is the primary mode of transmission in endemic areas like Ethiopia. The aim of this study was to determine the prevalence of HBV infection, rate of MTCT, and associated risk factors among delivering mothers. Methods: This health facility-based cross-sectional study was conducted in four public hospitals of the Eastern zone of Tigray among 473 delivering mothers. Structured questionnaires and laboratory results were used to collect the data. The data were checked for completeness and entered into EpiData manager version 4.6.0.0. Then the data were exported to Statistical Package for Social Sciences (SPSS) version 23. The odds ratio, along with a 95% confidence interval, was estimated to identify predictors of HBV infection using multivariable logistic regression analysis. Significant association was considered at p < 0.05. Results: A total of 473 mothers were enrolled, and the response rate was 100%. The prevalence of HBV infection among the mothers and the rate of MTCT of the infection were 11.6% and 30.9%, respectively. History of home delivery [adjusted odds ratio (AOR) = 4.5, 95% confidence interval (CI) (2, 10.6)], history of hospital admission [AOR = 5, 95% CI (2.2, 11.5)], working at health facility [AOR = 5.4, 95% CI (1.4, 20.7)], body tattoos [AOR = 5.8, 95% CI (2.4, 13.6)], sharing personal care materials [AOR = 3.8, 95% CI (1.4, 9.9)], insufficient knowledge [AOR = 5.6, 95% CI (1.6, 19)], and having human immunodeficiency virus (HIV) [AOR = 5.1, 95% CI (1, 26.2)] were significantly associated with HBV infection. Conclusion: HBV infection among delivering women is becoming highly endemic, and the rate of MTCT was high. Therefore, administering hepatitis B vaccine to all neonates within 24 h of birth is mandatory to prevent MTCT of HBV infection and related complications. Furthermore, health education and dissemination of information about HBV for the pregnant mothers are needed to reduce HBV infection and vertical transmission in Ethiopia. [ABSTRACT FROM AUTHOR]

Developing intensity, duration, and frequency (IDF) of rainfall with the reflection of future climate change is required for designing and managing water infrastructures. Hence, this study was aimed to predict future changes in IDF information for seven stations of the Tigray Region. Observed hourly and spatiotemporally downscaled Hadley Center Climate Model version 3 (HadCM3) model output data sets via Statistical Downscaling Model (SDSM) 4.2.9 and Hyetos models were used. Gumbel [Extreme Value Type I (EVI)] distribution and MIDUSS IDF Curve Fit tool were employed for frequency analysis and estimation of IDF equation parameters. Finally, general trends for three future climate timelines were established. The result revealed that the rainfall intensity is expected to decrease by 15.9%, 14.7%, and 20.3% for short storms and increase by 21.3%, 26.9%, and 18.9% for longer storms in the 2020s, 2050s, and 2080s, respectively, with frequent intensive rainfall occurrences by the 2020s and 2050s under the A2 emission scenario (high emission scenario). These have a great message to which the existing and future water management facilities are designed, functioned, and sustained. Thus, design facilities need to be updated as per the reflection of climate change impacts. [ABSTRACT FROM AUTHOR]

Background: Religious institutions found in the community not only uphold belief and cultural values but can also act as a force for positive change and development. Improved sanitation and hygiene are crucial in these institutions to decrease preventable infections due to unsanitary conditions. However, there are no studies among religious institutions on availability of latrines. Therefore, this study was conducted to assess latrine availability and associated factors among religious institutions in the Tigray Region, Ethiopia.Method: An institution-based cross-sectional study design was conducted in the Tigray Region, Northern Ethiopia. Multistage sampling was used to sample 385 religious institutions. Data were collected using a pretested, structured questionnaire and observation checklist. Logistic regression was fitted, and an odds ratio with 95% confidence interval (CI) with p value less than 0.05 was used to determine the predictors of latrine availability. Analysis was carried out using the SPSS 20TM software package.Results: In this study, latrine availability was 32.8%. It was significantly affected by currently saved money towards having a latrine (adjusted odds ratio (AOR): 0.32, 95% confidence interval (CI) [0.25, 0.42]), any messages seen, heard, or received on sanitation and hygiene (AOR: 0.43, 95% CI [0.38, 0.51]), and the place where messages were seen, heard, or received (AOR: 2.95, 95% CI [1.11, 5.55]).Conclusion: Latrine availability was very low when compared to the national target of 100% among religious institutions and was affected by the currently saved money towards having a latrine, any messages seen, heard, or received on sanitation and hygiene, and the place where the messages were received. Information regarding latrine availability should be provided to the community visiting religious institutions through available channels and promotion of practical models. [ABSTRACT FROM AUTHOR]

Background: Volatile organic compounds such as gasoline and other fuels are associated with a wide variety of deleterious health effects including liver and kidney diseases. Gasoline station workers are exposed to a mixture of hydrocarbons during dispensing. However, no published studies investigated the liver and renal function tests of gasoline station workers in Ethiopia. Therefore the aim of this study was to assess liver and renal function tests among gasoline station workers. Method: A comparative cross sectional study was conduct from January 2018 to April 2018 at Mekelle city, Tigray region, Northern Ethiopia. Liver and renal function tests were analyzed on gasoline exposed (n = 43) and controls (n = 47) by Pentra C400 automated clinical chemistry analyzer. Student independent t-test and one way-ANOVA statistical methods were employed using SPSS Ver23. P-value < 0.05 was regarded as statistically significant. Result: The mean level of ALT, AST, Urea, creatinine, and uric acid was significantly higher among gasoline stations workers when compared to control study participants. There was also a significant increase in ALT, AST, Urea, creatinine and uric acid among gasoline stations with above 6 years exposure when compared with those exposed for ≤2 and3-6years. Conclusion: These findings suggest that increasing liver and renal parameters may be associated with exposure to gasoline and it is dependent on time of exposure to gasoline. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis disease is the leading cause of death worldwide along with HIV/AIDS. Sputum smear microscopy plays an essential role for initial TB diagnosis and treatment follow up. But, misdiagnosis of sputum smear microscopy revealed a high economical crisis and missing of active TB cases. This study was aimed to determine blinded rechecking of sputum smear microscopy performance in public health facilities in Tigray region, Northern Ethiopia. Materials and methods: A cross sectional retrospective study was conducted from January, 2017 to December, 2018 year. Data was collected retrospectively using electronic and paper based in Tigray health research institute. The data was analyzed using the SPSS version 25 software. The sensitivity, specificity, positive predictive value, and negative predictive value of the smear readings were calculated using 2X2 contingency table. The reading agreement between the microscopic center and reference center was determined using kappa statistics. Results: A total of 23,456 blinded rechecked smear results were reviewed. In average, the performances of sputum smear quality were 61%, 68%, 64%, 66%, 62% and 75% for specimen quality, staining quality, smear size, smear thickness, smear evenness and smear cleanliness respectively. Of the total error (0.48%) reported, 0.25%, 0.19% and 0.085% were false positive, false negative and quantification errors respectively. The concordance rate of health facilities for smear reading was increased to 90% by the end of 2018. Overall, the sensitivity, specificity, PPV, and NPV of the smear readings were 95%, 99.7%, 93% and 99.8% respectively. Likewise, the smear reading agreement was also perfect with kappa value, 0.87. Conclusion: The overall performance of public health facilities for blinded rechecking of smear microscopy was satisfactory. But, the high false positive and false negative errors found calls for continuous evaluation and monitoring of the health facilities by reference center. [ABSTRACT FROM AUTHOR]

Background. Diabetic nephropathy is real damage resulting from having uncontrolled diabetes mellitus. Unmanaged diabetic nephropathy is one of the most leading causes of kidney failure. There is a scarcity of information on the determinants of diabetic nephropathy among diabetes mellitus patients in Ethiopia. Identification of the determinants can help devise a strategy to properly address the disease and its consequences. Therefore, this study was designed to assess the determinants of diabetic nephropathy among diabetes mellitus patients. Methods. Unmatched case-control study design with 168 cases and 672 controls with a mean age of 45.18 and 62.12, respectively, participated in the study. An interviewer-administered questionnaire was employed for data collection, and a systematic sampling technique was used to select the study participants. Data were entered into Epi data and exported to SPSS for data clarification and analysis. Binary logistic regression analysis was carried out to check the level of association between diabetic nephropathy and the independent variables. Results. Comorbidity (AOR: 4.96 at 95 CI: 1.77–13.87), hypertension (AOR: 6.33, 95% CI: 2.51–16.02), poor glycemic control (AOR: 3.27, 95% CI: 1.31, 8.21), age (AOR: 1.14, 95%: 1.09–1.19), duration with diabetes mellitus since diagnosis (AOR: 1.83, 95 CI: 1.62–2.06), and nonadherence to diabetic medication (AOR: 3.3, 95% CI: 1.34, 8.15), diet (AOR: 5.96, 95%: 1.92–18.54), and exercise (AOR: 5.60, 95% CI: 1.94–16.21) were the determinants of diabetic nephropathy. Conclusion. Adherence to medication, diet, and exercise should be empowered to achieve glycemic control and to prevent diabetic nephropathy. More attention has to be also given for old aged diabetic patients, long duration since diagnosis of diabetes mellitus, hypertension, and other comorbidities. [ABSTRACT FROM AUTHOR]

aimanot Tesfay Gebreagziabher, Guesh Teklu Woldemariam Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Adigrat, EthiopiaCorrespondence: : Teklehaimanot Tesfay Gebreagziabher Tel +251946918227Email teklehaimanot.tesfay@adu.edu.etGuesh Teklu Woldemariam Tel +251-940304140Email gueshomt21@gmail.com Background: Human immune deficiency virus is a significant cause of morbidity and mortality, especially in developing countries. Globally, about 37.9 million people had HIV/AIDS in 2018 and 36.2 million people were adults, Moreover, about 770,000 AIDS-related mortality occurred in adult infected people. Appropriate antiretroviral therapy adherence is important to minimize drug resistance, improve virological response, and decrease morbidity and mortality. Researches done in Ethiopia reported knowledge on antiretroviral therapy adherence and determinant factors were limited and the literature was scared. Moreover, the eastern zone of Tigray was inhabited with a highly rural population and this may be a significant facilitator and barrier to ART adherence. According to a census conducted by the central agency of Ethiopia in 2013, the eastern zone of Tigray has a population of 755,343, of whom 395,705 are women and 609,279 (80.66%) are rural inhabitants. Objective: This study aimed to assess antiretroviral therapy adherence and determinant factors among Adult HIV infected people in eastern Tigray, 2019. Methods: A cross-sectional study design was conducted from January 1 to June 30 2019 on 339 adults attending the antiretroviral clinic at eastern Tigray. A systematic random sampling method was used to pick the study samples. Data were collected by a structured questionnaire using face to face interview. P-value < 0.05 in multivariate analysis was used as a cut-point for the statistical significance of the association. Results: About 74.6% of participants were adhering to antiretroviral therapy. Place of residence (AOR= 5.13 (1.63– 13.44), social support (AOR=2.71 (1.37– 9.74), HIV disclosure (AOR=3.32 (1.43– 9.24), free from depression (AOR=2.54 (1.36– 9.43) and free from substance use (AOR=3.42 (1.67– 10.87) were the factors associated with adherence to antiretroviral therapy. Conclusion and Recommendation: Drug adherence in eastern Tigray was low and place of residence, social support, HIV disclosure, free from depression and free substance use were the factors associated with ART. So, awareness creation for rural residence, social support, avoidance of depression, and substance use should be strengthened to increase drug adherence. [ABSTRACT FROM AUTHOR]

In Ethiopia, like most developing countries, the majority of households depend on wood and charcoal as their cooking energy resources. This energy has a direct impact on the forest coverage and its emissions have significant health issues. Biogas technology has introduced to address these problems and reduce energy poverty in developing countries. However, the success of this technology depends on many factors such as technology appropriateness, available skill, proper introduction, and government support to create favorable financial incentives. The objective of this paper is to make an overview assessment of biogas development programs in Ethiopia, identify development barriers and provide suggestions to mitigate these barriers. The national and regional biogas program of Ethiopia has implemented to give energy for cooking and to some extent for lighting. However, it has shown limited success over the years. The National Biogas Programme of Ethiopia has shown an overall 50% achievement while the Tigray region registered 55% achievement. In addition, the owner of the biogas facility in Tigray reported a 57% functionality rate but the lowest satisfaction level of 15%. Generally, the region has shown relatively better performance in terms of dissemination and functionality but a low satisfaction rate due to technical limitation, unsteady input, and financial factors. [ABSTRACT FROM AUTHOR]

Introduction: Addressing malnutrition is one of the key components of HIV care among people living with HIV. Since 2010, a nutritional program has been implemented to address malnutrition amongst HIV patients in Ethiopia, with patients enrolled in the program for 3 months (for mild acute malnutrition) and 6 months (for severe acute malnutrition). However, utilisation and effectiveness of the nutritional programs remain unexplored. This study aimed to examine individual level determinants and contextual factors influencing the effectiveness of the nutritional program in the Tigray region of Ethiopia. Methods and setting: The study employed a mixed-methods approach involving quantitative and qualitative research methods. In the quantitative phase of the study, records from 1757 adult patients, including socio-demographic characteristics, clinical and nutritional program outcomes were retrieved from three selected hospitals in the Tigray region, Ethiopia. Logistic regression analysis was used to identify the individual demographic and socioeconomic, clinical and immunological, and anthropometric and nutritional determinants of nutritional outcomes. The qualitative study included 33 individual interviews with adult patients, health providers, and program managers. Interview data were analysed using a framework analysis approach. Results: Amongst study participants, 55.3% (95% CI = 53.2‒57.4) recovered from malnutrition, 19% (95% CI, 17.3‒20.7) did not complete the program, and 21% (95% CI = 19.7‒23.4) completed the program but failed to recover from malnutrition. In the multivariable logistic regression analysis, those who were: living in urban areas (AOR = 1.44, 95% CI = 1.05‒1.97), employed (AOR = 1.39, 95% CI = 1.01‒1.93), attending Shul (AOR = 4.6, 95% CI = 3.15‒6.71) and Lemlem Karl (AOR = 2.5, 95% CI = 1.69‒3.71) hospitals, in clinical stages II (AOR = 2.49, 95% CI = 1.59‒3.91) and III (AOR = 1.46(1.02‒2.07), on ART for less than six months (AOR = 1.61, 95% CI = 1.09‒2.39), anaemic (AOR = 1.77, 95% = 1.29‒2.41), and diagnosed with severe acute malnutrition at enrolment (AOR = 6.43, 95% CI = 4.69‒8.3); were less likely to complete the program. Results for those who completed the program indicated that urban residence, (AOR = 1.46, 95% CI = 1.4‒2.91), attending Shul (AOR = 2.92, 95% CI = 2.04‒4.19) and Lemlem Karl (AOR = 1.49, 95% CI 1.05‒2.11) hospitals, having bedridden functional status (AOR = 0.36, 95% CI = 0.15‒0.83), advanced WHO clinical stage (WHO clinical stage IV) (AOR = 0.52, 95% CI = 0.28‒0.98) and severe malnutrition at enrolment (AOR = 4.25, 95% CI = 3.02‒5.98)) predicted non-response to the nutritional program. Qualitative interviews revealed that the taste and perceived side effects of the nutritional supplement provided as part of the nutritional program, sharing/selling practices, religious and sociocultural issues, distance and poor access to the health services were barriers to program utilisation. Nutritional counselling and health service-related factors such as a previous enrolment in the program and positive experience in the health service were enablers of program utilisation. Conclusion: There was a clear nexus between contextual factors such as distance, quality of health service and sociocultural factors, and individual patient characteristics with the effectiveness of the nutritional program. Taking individual and contextual factors into consideration in program design, planning and implementation is essential if the nutritional program in HIV care services is to achieve its goal in addressing malnutrition amongst people living with HIV. [ABSTRACT FROM AUTHOR]

Background. Medicines have become part of our day-to-day life. Due to different reasons, patients may not use all the medications dispensed to them. The storage of drugs at home promotes self-medication, which results in variety of adverse consequences. Global growth in health-seeking awareness and behavior among people has resulted in increment of medicine consumption over years. However, Ethiopians have little awareness about proper disposal of unused and expired pharmaceuticals. Besides, large quantities remain unused or expired since not all medications given to the consumers are consumed. Hence, this study could serve as an indicator for the country policy makers concerning pharmaceutical waste management. Objective. To assess knowledge, attitude, and disposal practice of unused and expired pharmaceuticals in the community of Adigrat city, Tigray, Ethiopia, 2019. Methodology. A cross-sectional study was conducted among 359 respondents from the residents of Adigrat city. Semistructured questionnaires, which focused on knowledge, attitudes, and disposal practices for unused and expired medications, were used to collect data from respondents. Epi-data 3.0 suite and the statistical package for social sciences (SPSS) version 20 were used in data entry and analysis. Results. All of the 359 returned questionnaires were valid for data entry and analysis. Of the 359 respondents, 57.7% were men and the majority (93%) were Orthodox Christians. Almost half of the respondents (50.14%) have good knowledge concerning the disposal of unused and expired pharmaceuticals. Most (82.2%) of the respondents have a positive attitude towards the disposal of unused and expired pharmaceuticals. Around fifty-two (52.4) of the respondents had unused medicines stored at home, with analgesics being the most common (41.5%). Around three-quarters (75.2%) and 63% of the respondents discarded unused and expired medicines in the garbage bins, respectively. Conclusion. Although the majority of the respondents had a positive attitude towards the disposal of unused and expired medications, almost half of the sample population were unaware of proper disposal practices. Furthermore, less were inclined to practice proper disposal of unused and expired medications in the city. Therefore, we recommend further studies that focus on how the disposal attitude of the population can influence their knowledge and practice of the disposal of unused and expired medications. [ABSTRACT FROM AUTHOR]