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Introduction: Despite Ethiopia’s policy intension to provide recommended vaccination services to underprivileged populations, inequity in polio immunization persist. Objective: This study examined inequity and trends in polio immunization and determinant factors among children age 12–23 months in Ethiopia between 2000 and 2019. Methods: Cross-sectional data from 2000, 2005, 2011, 2016 and 2019 Ethiopian demographic and health surveys were analyzed with the updated version of the WHO’s Health Equity Assessment Toolkit (HEAT) software. Six standard equity measures: equity gaps, equity ratios, population attributable risk, population attributable fraction, slope index of inequality and relative index of inequality were used. Datasets were analyzed and disaggregated by the five equality stratifiers: economic status, education, place of residence, sex of the child and regions. And multilevel logistic regression analysis was used to identify determinant factors. Results: Polio immunization coverage 34.5% (2000), 44.7% (2005), 44.3% (2011), 56.4% (2016) and 60.0% (2019). Wealth index-related inequity in coverage of polio immunization between quintiles 5 and 1were greater than 20 percentage points or higher for all surveys. The population attributable risk and population attributable fraction measure in 2011 indicate that the national polio immunization coverage in that year could have been improved by nearly 36 and 81 percentage points respectively if absolute and relative wealth driven inequity, respectively, had been avoided. Coverage varied across regions; the absolute difference between Addis Ababa and Afar Region in polio immunization was 74 percentage points in 2000 and 60 percentage points in 2019. At the individual level, factors like Wealth index, maternal education antenatal care (ANC), and place of deliver were showed statistical significance. At the community level region and place of residence significantly influence equity in polio immunization. Conclusion: Although polio immunization coverage gradually increased over time, in the 20-year survey periods, inequities in coverage by wealth, educational-status, urban-rural residence and administrative regions persisted. Increasing service coverage and improving equitable access to immunizations services may narrow the existing inequity gaps.

Alelgne Feleke,1 Metadel Adane,1 Asha Embrandiri,1 Gete Berihun,1 Zebader Walle,2 Awoke Keleb,1 Helmut Kloos3 1Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia; 2Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 3Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USACorrespondence: Alelgne Feleke; Metadel Adane, Email alelgnefe@gmail.com; metadel.adane2@gmail.comBackground: Knowledge, attitudes, and misconceptions of students about COVID-19 (coronavirus disease) prevention have been examined in relatively few studies. This study aimed to assess the knowledge, attitudes and misconceptions about COVID-19 prevention practices among high and preparatory school (grades 9 to 12) students in Dessie City, Ethiopia.Methods: This school-based cross-sectional study used a pre-tested structured questionnaire and direct observations from March 1 to 30, 2021 in 5 high and preparatory school students in Dessie City, Ethiopia. The sample size was proportionally allocated in each school based on the number of students registered in the first semester, stratified by grade level, and section. Data analysis employed 3 binary logistic regression models (Models I, II and III) with 95% CI (confidence interval). Bivariate analysis (crude odds ratio [COR]) and multivariable analysis (adjusted odds ratio [AOR]) were used. Variables with P-values < 0.3 in the bivariate analysis were retained in the multivariable logistic regression analysis for each model. Variables with significance levels P< 0.05 in the multivariable analysis of each model was identified as significant factors.Results: The levels of good knowledge, positive attitudes, and low misconceptions were 74.8%, 60.2%, and 56.1%, respectively. After adjusting for the covariates, grade 12, positive attitude and living in households with more than 5 members were identified as factors significantly associated with good knowledge about COVID-19 prevention practices. Good knowledge of COVID-19 prevention practices, household size > 5, infection prevention and control (IPC) training, and low level of misconceptions were factors significantly associated with positive attitudes, whereas students age ≥ 18 years, positive attitude, and IPC training were factors significantly associated with less misconceptions about COVID-19 prevention measures.Conclusion: The prevalence of good knowledge, positive attitude, and low level of misconceptions of prevention practices for COVID-19 among students was relatively low. Therefore, Dessie City Health and Education Department and each high and preparatory school should implement continuous monitoring programs to ensure high prevention awareness and promote preventive behavior towards COVID-19.Keywords: COVID-19, knowledge, attitudes, misconceptions, high and preparatory school, students, Dessie City, Ethiopia

Coffee wilt disease (CWD) is caused by a pathogenic fungus, Gibberella xylarioides (anamorph = Fusarium xylarioides) and causes extensive damage to Arabica coffee (Coffea arabica). Trichoderma species are efficient bio-control agents against plant pathogens. This study evaluated the antagonistic activity of Trichoderma isolates from rhizospheric soil of C. arabica against G. xylarioides in Dello Mena and Harenna Buluk districts, southeastern Ethiopia. The study also evaluated the activity of solvent extracts of Trichoderma isolates against G. xylarioides. Dual culture assay, mycelial confrontations assay and Thin Layer Chromatography (TLC) direct bioautographic procedures were used to study the biocontrol efficacy of Trichoderma isolates against G. xylarioides. The Trichoderma isolates displayed 55.6% (MUT-2) to 80% (MUT-1) inhibitory activity against G. xylarioides. Mycoparasitism was detected and the major mechanisms of action were coiling, sporulation and disintegration of hyphae of G. xylarioides. The highest activity of Pakdaman’s biological control index value (PCBI = 0.19) was recorded for isolate MUT-1. TLC-direct bioautography assay revealed a total of 54 inhibition spots and a diameter of inhibition spots ranging from 0 to 30 mm in the interaction of solvent extracts of Trichoderma isolates and G. xylarioides. In the study areas, the coffee rhizosphere contains Trichoderma isolates with promising inhibitory activities against G. xylarioides. Based on the evaluated parameters, Trichoderma isolate MUT-1 followed by MUT-3 was considered to have very high biocontrol efficacy and be a potential candidate in the management of CWD. We recommend studies on identification of bioactive compounds of Trichoderma isolates for biological control of CWD.

Background Diarrheal disease is a leading cause of child mortality and morbidity worldwide. Household water treatment with chlorine significantly reduces morbidity due to waterborne diseases. However, the effect of point-of-use (POU) water treatment in improving the quality of water in areas where POU is not provided free of charge and the effectiveness of home visits in inspiring household members to use POU regularly have not been studied. The objective of this study was to evaluate the effectiveness of drinking water disinfection by chlorination on diarrheal disease reduction among children under the age of 5 years in rural eastern Ethiopia. Methods A cluster randomized controlled trial was carried out in rural Dire Dawa from October 2018 through January 2019. The 405 households were randomized to intervention and control arms and intervention materials were distributed after conducting a baseline survey. This trial evaluated the effectiveness of household drinking water disinfection by chlorination in reducing incidence of diarrhea among children under the age of 5 years. Intervention households received 1.2% sodium hypochlorite with demonstration of its proper use. Participants in the control households continued with their usual habits of water collection and water storage. Generalized estimation equations (GEE) with log link Poisson distribution family and exchangeable correlation matrix was used to compute crude incidence rate ratio (IRR), adjusted IRR and the corresponding 95% confidence intervals. Results In the intervention households, in total, 281 cases of diarrhea were documented (8.7 cases per 100 person-weeks observation); in the control households, in total 446 cases of diarrhea were documented (13.8 cases per 100 person-weeks observation). A 36.0% (adjusted IRR = 0.64, 95% CI: 0.57–0.73) reduction in incidence of diarrhea was observed in the intervention arm when compared with the control arm. The highest and the lowest reductions were obtained in children of age ranges 1 to 2 years and 3 to 4 years, 42.7 and 30.4%, respectively. Adherence to the intervention was 81.3% as measured by free residual chlorine test. Conclusions In rural areas where diarrhea is the second leading cause of morbidity, water chlorination at the household level using liquid bleach considerably reduced episodes of diarrhea among children under the age of 5 years. Therefore, chlorinating drinking water at the household level may be a valuable interim solution for reducing the incidence of diarrheal diseases until potable water is made accessible to the majority of the population in Dire Dawa Administration and other Ethiopian communities. Trial registration PACTR, PACTR201807815961394. Registered 16 July 2018, www.pactr.org

Discharging volumes of leather tanneries’ wastewater into the environment without proper treatment is causing severe environmental and public health problems. Therefore, this research aimed to remove chromium ion from tannery wastewater through the adsorption of activated carbon produced from the weed Parthenium hysterophorus. The activated carbon was characterized using proximate analysis, scanning electron microscope, Fourier transforms infrared spectroscopy and an iodine test. Full factorial experimental design of 24 was employed with four factors at two levels pH (2 and 6), contact time (45 and 90 min), initial chromium concentration (40 and 100 mg/L) and adsorbent dosage (9 g/L and 90 g/L), which resulted in 16 experimental runs. The average tannery effluent characteristics were described in terms of Five days biochemical oxygen demand: 1472.00 ± 9.300 mg/L; chemical oxygen demand: 1800.00 ± 50.00 mg/L; total solids: 29,000.00 ± 1000.00; temperature: 21.50 ± 2.01 °C; electrical conductivity (EC): 29.20 ± 1.60 mS/cm and pH: 4.30 ± 0.71. The mechanism of adsorption was tested by the Langmuir and Freundlich isothermal models. Maximum chromium removal of 90% was recorded at the optimum point of pH 2, contact time 90 min and adsorbent dose 90 g/L at initial chromium concentration 100 mg/L. Similarly, the treatment of the real tannery wastewater treatment was performed at the optimum point, which resulted in 89% chromium removal. Experimental data were best fitted with the Freundlich model at the adsorptive capacity 24.8 mg/g. This indicates that the application of this activated carbon for tannery wastewater treatment may be scaled up to mitigate industrial effluent pollution challenges, but detailed investigations of the adsorbent properties remain to be studied.

Background Needle stick and sharp injuries (NSSIs) are a common problem among healthcare workers (HCWs). Although the factors related to NSSIs for HCWs are well documented by several studies in Ethiopia, no evidence has been reported about the magnitude of and factors related to NSSIs in hospitals in northwestern Ethiopia. Methods An institution-based cross-sectional study was carried out from January to March 2019 among 318 HCWs in three randomly-selected hospitals of the eight hospitals found in South Gondar Zone. Sample sizes were proportionally allocated to professional categories. Study participants were selected by systematic random sampling methods using the monthly salary payroll for each profession as the sampling frame. Data were collected using a self-administered questionnaire. The outcome of this study was the presence (injured) or absence of NSSIs during the 12 months prior to data collection. A binary logistic regression model with 95% confidence interval (CI) was used for data analysis. Variables from the bi-variable analysis with a p-value ≤ 0.25 were retained into the multivariable analysis. From the multivariable analysis, variables with a p-value less than 0.05 was declared as factors significantly associated with NSSIs. Main findings The prevalence of NSSIs was 29.5% (95% CI: 24.2–35.5%) during the 12 months prior to the survey. Of these, 46.0% reported that their injuries were moderate, superficial (33.3%) or severe (20.7%). About 41.4% of the injuries were caused by a suture needle. Factors significantly associated with NSSIs were occupation as a nurse (adjusted odds ratio [AOR] = 2.65, 95% CI: 1.18–4.26), disposal of sharp materials in places other than in safety boxes (AOR = 3.93, 95% CI: 2.10–5.35), recapping of needles (AOR = 2.27, 95% CI: 1.13–4.56), and feeling sleepy at work (AOR = 2.24, 95% CI: 1.14–4.41). Conclusion This study showed that almost one-third of HCWs had sustained NSSIs, a proportion that is high. Factors significantly associated with NSSIs were occupation as a nurse, habit of needle recapping, disposal of sharp materials in places other than in safety boxes and feeling sleepy at work. Observing proper and regular universal precautions for nurses during daily clinical activities and providing safety boxes for the disposal of sharp materials, practicing mechanical needle recapping and preventing sleepiness by reducing work overload among HCWs may reduce the incidence of NSSIs.

This paper presents results of population based surveys of intestinal parasitism among 242 settlers and 320 indigenous people in and around 3 resettlement schemes in Illubabor Administrative Region in western Ethiopia. Overall prevalence rates in settlers were 61.6% and in indigenous people 65.0%. Ascaris lumbricoides was the most common parasite in 5 of the 6 study communities, followed by hookworm, Trichuris trichiura, Entamoeba histolytica and Giardia lamblia, in that order. Only one case of schistosomiasis mansoni was found and no host snails, further indicating that its prevalence is still low in most of western Ethiopia. Differences in the prevalence of intestinal parasitism among the study communities appear to be associated with environmental sanitation, water supply and socio-economic status of households, although this needs to be verified in more extensive follow-up studies.

Rapid urbanization and industrialization are increasing fresh water consumption and lead to a corresponding rise in wastewater generation. Because of insufficient capacity of wastewater treatment, many of Addis Ababa’s residents are forced to dispose domestic waste into the environment. The purpose of this study was to characterize wastewater and evaluate the performance of constructed wetland. The physicochemical and bacteriological parameters of municipal wastewater was analysed in dry and wet seasons. Three parallel pilot horizontal subsurface flow constructed wetland was constructed, lined with polyethylene and filled with gravel. The two HSSFCW cells were planted with Vetiveria zizanioides and Phragmites karka while one cell was unplanted and used for control. The wastewater was loaded with 0.177 m3/day flow rate at hydraulic loading rate of 0.05 m/day with a hydraulic retention time of 3 days. Standing nutrient accumulation and aboveground biomass of plants were determined. The findings revealed a significant difference in concentration of COD, BOD5, NH4+ and temperature of the municipal wastewater between dry and wet seasons. The HSSFCW cell planted with V. zizanioides removed more TSS (96.7%), BOD5 (92%), COD (90.8%), TP (88.5%), TC (4.7 log units) and E. coli (4.1 log units) than that planted with P. karka. The maximum above-ground dry biomass and the maximum standing nutrient accumulation were achieved by P. karka than V. zizanioides at the end of experiment. It was concluded that the HSSFCW cells planted with V. zizanioides and P. karka have a potential of removing nutrients, organic matter and pathogen efficiently and was not affected by seasonal variation.

Predictive modelling corroborates decision-making in the development of a standard habitat assessment protocol. In this study, we modelled environmental requirements of benthic macroinvertebrates. Classification and regression tree models (CART) and ordination analysis were performed to identify important variables affecting macroinvertebrate community pattern in the Lake Tana Watershed. A dataset of 95 samples was collected from eight wetlands. Among the modelled taxa, Coenagrionidae and Libellulidae had substantial predictive performance based on Kappa statistic (ĸ > 0.6) whereas Baetidae, Physidae, Tipulidae and Hydrophilidae had moderate predictive model performance (ĸ ≥ 0.4). Vegetation cover, leather tanning, vegetation clearance and nitrate ion were the topmost selected environmental variables influencing the occurrence of macroinvertebrate taxa. The conditional analysis depicted that the abundance of Coenagrionidae and Libellulidae increased with the increasing in vegetation cover. Overall, macroinvertebrate taxa have a clear habitat requirement within the habitat gradient studied and hence, could be a potential candidate for biomonitoring and provide valuable information in the development of a standard wetland assessment protocol.

A study was conducted to assess the performance of an integrated system consisting of an anaerobic digester (AD), an aerobic sequence batch reactor (ASBR), and three horizontal subsurface flow constructed wetlands (HSSFCWs) vegetated with the perennial grass Phragmites karka for removal of nitrogen in tannery wastewater. Nine grab wastewater samples were collected weekly between September and December 2016 from the influent and effluent at each unit of operation of the plant and analyzed for physicochemical parameters. The AD removed 67% of oxidized nitrogen (NO X –N); the removal was improved to 76% in the ASBR with a further aeration period in the HSSFCWs, and the NO X –N removal efficiency improved progressively to 96%. The removal efficiency for nitrate (NO3–N) was 82% and for nitrite (NO2–N) 88%; for ammonium (NH4–N) removal efficiency was 77% higher in the HSSFCWs compared to the AD and the ASBR. Despite the considerable percentage of NO3–N removed, in the effluent was above the country’s permissible limit (39.3 mg/l). The high concentration might be due to a weaker denitrification process in HSSFCWs caused by lack of carbon and external organic sources in the wastewater sufficient to carry out the process. The results suggest that the addition of supplementing carbon sources (methanol, sugars, or volatile fatty acids) to the effluent would achieve better performance. Based on these findings, the application of combined anaerobic/aerobic system connected with constructed wetlands process allows the achievement of higher efficiency in removing nitrogen compared to the use of an anaerobic, aerobic, or constructed wetland system along.

Inadequate improved water supply and sanitation, particularly in refugee camps contribute to the spread of infectious diseases. The study objective was to assess determinants of microbiological quality of drinking water in refugee camps and host communities in Gambella Region, Ethiopia. A cross-sectional study was conducted from September to December 2016 based on structured questionnaire-based interviews and testing household water using the portable Potatest+ water quality testing kit. Data were analyzed and P values

A pilot horizontal subsurface flow constructed wetland (HSSFCW) was constructed, covered with geomembrane, and packed with gravel as substrate. Phragmites karka was planted in one cell and the other cell was left unplanted. The experiment was carried out over a 3-year period at two hydraulic loading rates (HLRs): 0.025 m/d and 0.05 m/d. The aim of the study was to evaluate the phytoremediation and biomass production potential of Phragmites karka for municipal wastewater treatment to remove chemical oxygen demand (COD), total nitrogen (TN), and total phosphorus (TP). The highest average COD, TN, and TP removal performances attained were 94.1%, 97.3%, and 89.9%, respectively, at HLR of 0.025 m/d, and 90.4%, 86.8%, and 88.5%, respectively, at HLR of 0.05 m/d. COD, TN, and TP removal performances were considerably higher in the planted HSSFCW than in the unplanted (p

Background Poor menstrual hygiene practices influence school girls’ dignity, well-being and health, school-absenteeism, academic performance, and school dropout in developing countries. Despite this, menstrual hygienic practices are not well understood and have not received proper attention by school WASH programs. Therefore, this study examined the extent of good menstrual hygiene practices and associated factors among high school girls in Dessie City, Amhara Region, northeastern Ethiopia. Methods A school-based cross-sectional study was employed to examine 546 randomly selected high school students in Dessie City, northeastern Ethiopia. Pretested interviewer-administered questionnaires and a school observational checklist were used for data collection. EpiData Version 4.6 and the Statistical Package for the Social Sciences Version 25.0 were used for data entry and analysis, respectively. Bivariate and multivariable logistics regression analyses were employed to identify factors associated with good menstrual hygiene practices. During bivariable analysis, variables with P-values less than 0.25 were retained for multivariable analysis. In the multivariable analysis, variables with a P-value less than 0.05 were declared to be significantly associated with good menstrual hygiene practices. Results Of the respondents, 53.9% (95% CI [49.6, 58.2]) reported good menstrual hygiene practices. The following factors were found to be significantly associated with good menstrual hygiene practices: age range 16–19 years (AOR = 1.93, 95% CI: [1.22–3.06]); school grade level 10 (AOR = 1.90, 95% CI: [1.18–3.07]); maternal education (primary) (AOR = 3.72, 95% CI: [1.81–7.63]), maternal education (secondary) (AOR = 8.54, 95% CI: [4.18–17.44]), maternal education (college) (AOR = 6.78, 95% CI: [3.28–14.02]) respectively]; having regular menses [AOR = 1.85, 95% CI: (1.03–3.32); good knowledge regarding menstruation (AOR = 2.02, 95% CI: [1.32–3.09]); discussing menstrual hygiene with friends (AOR = 1.79, 95% CI: [1.12–2.86]), and obtaining money for pads from the family (AOR = 2.08, 95% CI: [1.15–3.78]). Conclusion We found that more than half of high school girls had good menstrual hygiene practices. Factors significantly associated with good menstrual hygiene practices include high school girls age 16–18 years, girls grade level 10, maternal education being completed primary, secondary and college level, having regular menses, good knowledge regarding menstruation, discussing menstrual hygiene with friends and obtaining money for pads from the family. Therefore, educating of high school student mothers about MHP should be a priority intervention area to eliminate the problem of menstrual hygiene among daughters. Furthermore, in order to improve the MHP among high school girls, further attention is needed to improving knowledge regarding menstruation among high school girls, encouraging high school girls’ families to support their daughters by buying sanitary pads and promoting discussions among friends about menstrual hygiene. Schools need to focus on making the school environment conducive to managing menstrual hygiene by increasing awareness of safe MHP and providing adequate water/sanitation facilities.

Background Since Ethiopia has been implemented the Community-Led Total Sanitation and Hygiene (CLTSH) approach to control incidence of diarrhea, few studies have compared the prevalence of diarrhea and associated factors in rural areas that have implemented this approach with those that have not implemented it, and none have examined it in the district of Menz Gera Midir in the Amhara Region of Ethiopia. This study addressed this gap. Method A community-based comparative cross-sectional study was conducted among 224 children under five in three randomly selected rural kebeles (the smallest administrative units in Ethiopia) where CLTSH had been implemented and 448 similar children in three other randomly selected rural kebeles where CLTSH had not been implemented during February and March, 2020. Data were collected using a structured questionnaire and an on-the-spot observational checklist. Data were analyzed using three different binary logistic regression models with 95% confidence interval (CI): the first model (Model I) was used for CLTSH-implementing kebeles, the second model (Model II) for non-CLTSH-implementing kebeles, and the third model (Model III) for pooled analysis of CLTSH-implementing and non-implementing kebeles. To control confounders, each multivariable logistic regression model was built by retained variables with p p-values Results The prevalence of acute diarrhea among children under five from households in kebeles that had implemented CLTSH was 10.6% (95% CI:6.6–14.7%) and among those that had not implemented CLTSH 18.3% (95%CI:14.8–22.2%). In CLTSH-implementing areas, use of only water to wash hands (AOR: 3.28; 95% CI:1.13–9.58) and having a mother/caregiver who did not wash their hands at critical times (AOR: 3.02; 95% CI:1.12–8.12) were factors significantly associated with acute diarrhea. In non-CLTSH-implementing areas, unimproved water source (adjusted odds ratio [AOR]: 2.81; 95% CI:1.65–4.78), unsafe disposal of child feces (AOR: 2.10; 95% CI:1.13–3.89), improper solid waste disposal (AOR: 1.95; 95% CI:1.12–3.38), and untreated drinking water (AOR: 2.33; 95% CI:1.21–4.49) were factors significantly associated with acute diarrhea. From the pooled analysis, not washing hands at critical times (AOR: 2.54; 95% CI:1.59–4.06), unsafe disposal of child feces (AOR: 2.20; 95% CI:1.34–3.60) and unimproved water source (AOR: 2.56; 95% CI:1.62–4.05) were factors significantly associated with the occurrence of acute diarrhea while implementation of CLTSH was a preventive factor (AOR: 0.24; 95%: 0.20–0.60) for the occurrence of acute diarrhea. Conclusion The prevalence of acute diarrhea among under-five children in Menz Gera Midir District was lower in kebeles where CLTSH had been implemented than in kebeles where CLTSH had not been implemented. Therefore, we recommend that governmental and non-governmental sectors increase implementation of CLTSH programs, including improving handwashing at critical times, promoting safe disposal of child feces and enhancing the availability of improved water sources.

Background Handwashing with soap reduces diarrheal diseases burden considerably. However, the importance of handwashing in homes has received little attention in rural eastern Ethiopia. The effectiveness of handwashing may be reduced by lack of information on when and in what event hands must be washed, the frequency of handwashing, the individual who should wash his/her hands, and the procedure of handwashing. In these areas, indicators of adherence to handwashing are yet to be established. This study aimed at assessing the efficiency of handwashing on reducing diarrheal disease in children under 5 years old in rural kebeles of Dire Dawa, east Ethiopia. Methods Community-based cluster randomized controlled trial was conducted in rural kebeles of Dire Dawa for 4 months starting from October 2018 to January 2019. Selected clusters were randomized in intervention and control arms using draw method and data collectors conducted the baseline survey. Households assigned to the intervention group were given two bars of plain soap on a bi-monthly basis together with information promoting hand hygiene. Control households were allowed to continue their habitual handwashing practices. We compared the diarrheal incidences of the intervention and non-intervention households. Generalized estimation equations using Poisson family and log choice of the link was employed to calculate adjusted incidence rate ratio with its 95% confidence interval. Results We recorded a significant lesser diarrheal incidence in the handwashing arm than in the non-intervention arm (6.9 versus 13.8 episodes per 100 person weeks of observation). In all, there was a 41% reduction in diarrheal incidence in the intervention arm in relation to the non-intervention arm. Conclusion Handwashing with soap complemented with hand hygiene promotion significantly decreased diarrheal episodes in children under 5 years old in rural kebeles of Dire Dawa. We recommend the promotion and adaptation of washing hands using soap at recommended times to be an effective means of reducing childhood diarrhea morbidity in rural populations of Ethiopia towards achieving the Sustainable Development Goal 6. Trial registration PACTR, PACTR201807815961394. Registered 16 July 2018

Background: Tuberculosis remains a major global health problem and ranks along with the human immunodeficiency virus (HIV) as a leading cause of mortality worldwide. The aim of this study was to investigate the treatment outcome of tuberculosis, and factors associated with treatment outcome of tuberculosis in TB patients enrolled in Arsi-Robe Hospital, Oromia regional state, South eastern Ethiopia between January 2013 to December 2017. Methods: An Institutional-based retrospective study was conducted in Arsi-Robe Hospital from 2013 to 2017 in study patients who had all forms of TB in DOTS clinic. The predictors of treatment outcomes were analyzed through bivariate and multivariable logistic regression analysis and a P-value < 0.05 were considered statistically significant. Results: Out of the 257 registered TB patients, most of them were males (57.9%), from rural areas (62.6%) and in age of 15-24 category (39.3%). PTB-, PTB+ and EPTB were recorded in 48.2%, 32% and 19.8% of the patients, respectively. Among all cases, 8.6% had TB-HIV co-infection. Among all TB cases, 84.0% had successful treatment outcome. TB patients from urban areas (AOR: 3.34, 95% CI: 1.33­8.38, P = 0.01), with failure treatment (AOR: 6.66, 95% CI = 1.12- 39.57; P = 0.037) and HIV positive (AOR: 4.92, 95% CI = 1.38-17.51; P = 0.014) had higher odd of unsuccessful treatment outcome of tuberculosis. However, TB patients with PTB+ (AOR: 0.1470, 95% CI = 0.031-0.687; P = 0.015) and EPTB (AOR: 0.194, 95% CI = 0.054-0.688; P = 0.011) had significantly lesser odd of unsuccessful treatment outcome. Conclusions: Being urban resident, treatment failure and HIV positive considerably challenge the treatment outcome of tuberculosis, but being PTB+ and EPTB were associated with higher treatment success rate of TB. Continuous follow-up of patients with unsuccessful treatment outcome of tuberculosis with strengthened implementation of the DOTs strategies are suggested. Trial Registered: retrospectively registered

Background: One challenge to achieving Millennium Development Goals was inequitable access to quality health services. In order to achieve the Sustainable Development Goals, interventions need to reach underserved populations, it appears that the maternal, newborn and child health goals (MDG 4 and 5) will not be universally achieved. There was early recognition that it could be possible to achieve the health goals while decreasing health inequity, because most of the gains might go to the better-off rather than to the very poor.Methodology/Design: The current protocol adopts a strategy informed by the guidelines of The Cochrane Handbook for Systematic Reviews. Our systematic review will identify studies in English, provided inclusion of an English abstract - from 2010 onwards till 2020, by searching MEDLINE (PubMed interface), EMBASE (OVID interface), Cochrane Central (OVID interface) and the gray literature. Study selection criteria include research setting, study design, reported outcomes and determinants of interest. Our primary outcome is inequity in utilization of child health care services, and determinants of concern are: 1) socioeconomic status (for example, income, education); 2) geographic determinants (for example, distance to a health center, rural versus urban residence); and 3) demographic determinants (for example, age, ethnicity, religion, and marital status). Screening, data abstraction, and scientific quality assessment will be conducted independently by two reviewers using standardized forms. Where feasible, study results will be combined through meta-analyses to obtain a pooled measure of association between utilization of child health care services and key determinants. Results will be stratified by income levels (World Bank classification) geographical residence and demographical determinants.Discussion: Our review will inform policy-making with the aim of decreasing inequities in utilization of child health care services. This research will provide evidence on unmet needs for child health care services in LMICs, knowledge gaps and recommendations to health policy planners. Our research will help promote universal coverage of quality child health care services as an integral part of the continuum of maternal and child health care. This protocol will be registered with the Prospero database.

BackgroundPneumonia is a leading cause of morbidity and mortality among children under five years of age in developing countries, including Ethiopia. However, data on this serious illness among highly susceptible and vulnerable children living in local peri-urban areas are limited. Establishing the prevalence of pneumonia and identifying the associated factors are important for proper planning and intervention.MethodsA community-based cross-sectional study was conducted among 560 systematically selected children under the age of five years in peri-urban areas of Dessie City from January through March 2019. Data were collected using a pretested structured questionnaire, physical examination of children and direct observation of housing conditions. Pneumonia was examined using World Health Organization (WHO) guidelines as the presence of the symptoms of fast breathing or indrawn chest with or without fast breathing during the two weeks prior to the study. A principal component analysis was used to construct a household wealth index. Data were analyzed using a binary logistic regression model at 95%CI (confidence interval). The analysis involved estimating the crude odds ratio (COR) using bivariate analysis, and adjusted odds ratio (AOR) using multivariable analysis. From the multivariable analysis, variables at p-value of less than 0.05 were declared statistically significant.Main findingsThe prevalence of pneumonia among children under five was 17.1% (95%CI: 13.9%-19.9%). Of the participating children, 113 (21.0%) had a cough, 92 (17.1%) had fast breathing, 76 (14.1%) had fever, and 40 (7.4%) of the children had chest indrawn. Domestic fuel was the most common source of cooking fuel 383 (71.1%). Majority 445 (82.6%) of children were fully vaccinated and 94 (17.4%) were not fully vaccinated. Most (481, 89.2%) of the children were got exclusive breastfeeding. Slightly more than half (284, 52.7%) of the under-five children had acute malnutrition and 27.1% of the children had a childhood history of ARI. The multivariable analysis showed using domestic fuel as the energy source for cooking (adjusted odds ratio [AOR] = 3.95, 95%CI: 1.47-10.62), cooking in the living room (AOR = 6.23; 95%CI: 1.80-21.68), overcrowding (AOR = 3.37, 95%CI: 1.56-7.27), child history of acute respiratory infection (ARI) (AOR = 6.12 95%CI: 2.77-13.53), family history of ARI (AOR = 4.69, 95%CI: 1.67-13.12) and acute malnutrition (AOR = 2.43, 95%CI: 1.18-5.04) were significantly associated with childhood pneumonia.ConclusionIn this study, pneumonia remains a leading public health problem among under five children in the study area and higher than national averages. Domestic fuel as the energy source for cooking, cooking in the living room, overcrowding, child history of ARI, family history of ARI and acute malnutrition were predictors of pneumonia. Community-based interventions focusing on improving housing conditions, reduced use of domestic biofuels, adequate and balanced food intake, including exclusive breastfeeding of infants, and early treatment of ARIs.

It is very exceptional that a new disease becomes a true pandemic. Since its emergence in Wuhan, China, in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has spread to nearly all countries of the world in only a few months. However, in different countries, the COVID-19 epidemic takes variable shapes and forms in how it affects communities. Until now, the insights gained on COVID-19 have been largely dominated by the COVID-19 epidemics and the lockdowns in China, Europe and the USA. But this variety of global trajectories is little described, analysed or understood. In only a few months, an enormous amount of scientific evidence on SARS-CoV-2 and COVID-19 has been uncovered (knowns). But important knowledge gaps remain (unknowns). Learning from the variety of ways the COVID-19 epidemic is unfolding across the globe can potentially contribute to solving the COVID-19 puzzle. This paper tries to make sense of this variability—by exploring the important role that context plays in these different COVID-19 epidemics; by comparing COVID-19 epidemics with other respiratory diseases, including other coronaviruses that circulate continuously; and by highlighting the critical unknowns and uncertainties that remain. These unknowns and uncertainties require a deeper understanding of the variable trajectories of COVID-19. Unravelling them will be important for discerning potential future scenarios, such as the first wave in virgin territories still untouched by COVID-19 and for future waves elsewhere.

Reproductive tract infections (RTIs) are a public health concern in Ethiopia. However, the relationship between menstrual hygiene management (MHM) and water, sanitation, and hygiene (WASH) factors to RTIs have not been well addressed. A community-based cross-sectional study was conducted from January to March 2019 among 602 systematically selected reproductive-age women aged 15-49 years in Dessie City. Data were collected using a questionnaire and a direct observation checklist. RTIs were identified by the presence during one year before data collection of one or more signs of vaginal discharge, itching/irritation or ulcers/lesions around the vulva, pain during urination and sexual intercourse, and lower abdominal pain and lower back pain. Data were analyzed using multivariable logistic regression analysis with 95%CI (confidence interval). The self-reported prevalence of RTIs was 11.0%(95%CI:8.5-13.7%) during one year prior to the survey. The most commonly reported symptoms of RTI were burning micturition (9.1%) and vaginal discharge (6.1%). Three-fourths 443(75.0%) of households used traditional pit latrines and the majority of the study participants 527(89.2%) did not meet the basic access requirement of 20 liters of water per capita per day. The majority 562(95.1%) of the study participants did not have multiple sexual partners during the last year and 97.8% did not practiced sexual intercourse during menstruation. The most common type of blood-absorbent material used was a sanitary pad 497(84.8%) followed by cloth 89(15.2%). Factors significantly associated with RTIs were using unclean latrines (AOR: 4.20; 95%CI:2.00-8.80), not washing hands with soap before touching the genital area (AOR: 3.94; 95%CI:1.49-10.45), history of symptoms of RTIs in the past year (AOR: 5.88; 95%CI:2.30-14.98), having multiple sexual partners in the past year (AOR: 4.46; 95%CI:1.59-12.53), changing absorbent material only once per day (AOR: 8.99; 95%CI:4.51-17.92), and washing the genital area only once per day during menstruation (AOR: 5.76; 95%CI:2.07-16.05). The self-reported prevalence of RTI showed that one women experienced RTI among ten reproductive-age women. Designing a women's health policy that focuses on ensuring availability of WASH facilities and improving MHM at the community level is key for sustainably preventing RTIs.

Objective: Evidence suggests postnatal care contributes to reductions in maternal mortality. In Ethiopia, the proportion of women who do not utilize postnatal care after birth is high and the frequency of postnatal checks falls short of the four visits recommended by World Health Organization. This study examined risk factors associated with non-utilization of decentralized local health facilities, namely, health posts, health centers, and a primary hospital, for postnatal care services in Gida Ayana Woreda in rural western Ethiopia. Methods: In this study, 454 mothers were examined for the following risk factors: kebele (the smallest administrative unit in Ethiopia) in which decentralized health care facilities were located, postnatal woman’s age, antenatal care service visit, experience of postnatal complications, knowledge of postnatal complications, knowledge of the recommended number of postnatal care visits, knowledge of the availability/provision of postnatal care, and health extension workers’ home visits. Bivariate and multivariable logistic regression analyses were applied to identify predictors of non-utilization of decentralized local facilities for postnatal care services. Results: Over half (55.7%) of the women did not utilize postnatal care within 42 days of delivery, and only 10.0% utilized the care considered appropriate according to World Health Organization guidelines. After adjusting for various potential confounding factors, we found the following risks to be strongly associated with non-utilization of decentralized health care facilities for postnatal care services: some outer rural administrative decentralization entities such as Angar, Lalistu, and Ejere kebeles; age 35 years or older (adjusted odds ratio = 3.4, 95% confidence interval: 1.4–8.3), not receiving antenatal care during this pregnancy (adjusted odds ratio = 2.0, 95% confidence interval: 1.1–3.7), no experience of any postnatal complications (adjusted odds ratio = 3.3, 95% confidence interval: 1.7–6.4), and no knowledge of at least one postnatal complication (adjusted odds ratio = 2.0, 95% confidence interval: 1.2–3.3). Risk factors highly but less strongly associated with women’s non-utilization of postnatal care services were no knowledge of the standard number of postnatal care visits recommended, no knowledge about the availability/provision of services at a local health facility, and no home visit from health extension worker by day 3 post-delivery. Conclusion: The risk factors for women’s non-utilization of decentralized health care facilities for postnatal care identified in this study need to be considered in interventions for enhancing the utilization of the service and reducing maternal and newborn deaths in rural western Ethiopia. Strengthening of postnatal care services, especially in the more remote kebeles, should include upgrading of the referral system and expansion of counseling of women by health extension workers.

In many developing countries, water supply sources are not well protected. However, many people depend on such water sources for their daily consumption. Hence, this study assessed the physicochemical and heavy metal constituents of drinking water and evaluated the quality of the potable water supply in Haramaya Woreda. Water samples were taken from five sampling sites. Physicochemical and heavy metal parameters were analyzed according to the procedures outlined in the APHA (Standard methods for the examination of water and wastewater, 21st edn. Washington DC, 2008). The results showed that the acidity ranged from 32.67 ± 1.15 to 45.33 ± 0.58 mg/L, alkalinity from 276.67 ± 1.15 to 391.00 ± 1.73 mg/L, total hardness from 271.67 ± 0.57 to 410.67 ± 0.58 mg/L, chloride from 32.90 ± 1.32 to 85.77 ± 0.25 mg/L, sulfate from 194.33 ± 0.58 to 250.67 ± 0.58 mg/L, nitrate from 1.93 ± 0.15 to 13.33 ± 1.53 mg/L, phosphate from 0.015 ± 0.001 to 0.053 ± 0.002 mg/L, COD from 9.33 ± 0.702 to 24 ± 1.000 mg/L, Ca from 61.13 ± 1.06 to 103.17 ± 1.26 mg/L, Cd not detected to 0.069 ± 0.004 mg/L, Cr not detected to 0.133 ± 0.002 mg/L, Fe from 0.123 ± 0.015 to 0.530 ± 0.008 mg/L, Pb not detected to 0.217 ± 0.040 mg/L, Zn from 0.135 ± 0.002 to 0.170 ± 0.003 mg/L, and Cu from 0.221 ± 0.002 to 0.288 ± 0.002 mg/L. Statistically significant differences (p

Lack of integrated solid waste management practice in fast-growing cities of developing countries is posing a threat to sustainable and green cities development. The fast growing Jimma City in Ethiopia requires up-to-date waste quantification and characterization data for the planning and implementation of sound waste management options such as composting and energy recovery that could create new jobs and promote private sector involvement. Therefore, we quantified, characterized and evaluated energy potential and nutrient value of household solid waste from Jimma City. Total daily waste generated from the city’s households was estimated to be 85.8 tons, with an average per capita generation rate of 0.56 ± 0.17 kg/day. The biodegradable organic waste comprises 76% by weight and had optimum moisture content and carbon to nitrogen ratio for composting. The energy content of combustible household waste was estimated to be 17.5 MJ/kg for gross heating value and 9.54 MJ/kg for the net heating value that surpasses the lower limit for thermal treatment process to be economically viable. Waste-to-energy conversion of combustible waste of cities could reduce annually about 25,303 metric tons of carbon dioxide equivalent greenhouse gas emissions. Char briquettes produced through pyrolysis of solid waste could be a potential substitute for firewood to prevent deforestation and indoor air pollution. In conclusion, composting and pyrolysis are sound waste management options for green cities development in developing countries while minimizing public health risks and cost of treatment and disposal.

The sugar industries and ethanol distilleries have been rapidly expanding globally since bioethanol emerged as a renewable bioenergy source. However, these industries generate large volumes of wastewater with high levels of organic matter, nutrients, and metal contents, which are discharged into the nearby environment without adequate treatment. This industrial pollution may have an adverse effect on aquatic and terrestrial ecosystems. Hence, this study aimed at investigating the physicochemical properties and metal constituents of sugar industry and ethanol distillery wastewater and its adverse effect on the environment. The study also assessed the legal framework of industrial wastewater management in the sugar–ethanol industry. The wastewater samples were collected from Metahara sugar factory and ethanol distillery using time-composite sampling techniques. The laboratory analyses of physicochemical parameters and metal constituents of the wastewater were performed using standard methods. Results show that the physicochemical properties of the sugar industry’s wastewater (mg/L) were pH 7.6 ± 0.5, total solids (TS): 3050 ± 628, 5 days biochemical oxygen demand (BOD5): 1052 ± 560, chemical oxygen demand (COD): 1752 ± 433.0, NO3− N: 0.4 ± 0.3, PO 4 −3 : 3.5 ± 1.5, SO 4 −2 : 30 ± 9.0 and Cl−: 45 ± 10.4, whereas the ethanol distillery parameters (mg/L) were pH 3.9 ± 0.1, TS: 150,300 ± 9200, BOD5: 40,271 ± 3014, COD: 132,445 ± 6655, NO3− N: 3.2 ± 1.0, PO 4 −3 : 21.2 ± 2.7, SO 4 −2 : 4502 ± 69 and Cl−: 6722 ± 873. The metal constituents of the sugar industry and ethanol distillery wastewater were, respectively: Na: 61.1–113.4, 207.6–263.0 mg/L; K: 87–161, 1143.9–2987.0 mg/L; Mg: 274.2–341.0, 816.3–927.6 mg/L; Ca: 376.9–468, 1787.4–3389.8 mg/L; Cr: 0.01–0.06, 0.8–2.3 mg/L; Cu: 0.2–0.7, 1.1–1.5 mg/L; Zn: 1.3–3.5, 1.4–2.8 mg/L; Fe: 3.2–4.3, 13.8–19.6 mg/L; Ni: not detected, 0.13–2.7 mg/L and Mn: 1–1.5, 1.5–6.6 mg/L. All except one bivariate correlation between concentrations of the metals were strong (r > 0.5). The BOD5/COD (biodegradability index) of the sugar industry was 0.60, whereas the ethanol distillery was 0.25. Analysis of variance showed the concentrations of metals in the two industries were statistically significant (p

The discharge of inadequately treated municipal wastewater has aggravated the pollution load in developing countries including Ethiopia. Conventional wastewater treatment methods that require high capital and operational costs are not affordable for many developing nations, including Ethiopia. This study aimed to investigate the performance of two high-rate algal ponds (HRAPs) in organic pollutant removal from primary settled municipal wastewater under highland tropical climate conditions in Addis Ababa. The experiment was done for 2 months at hydraulic retention times (HRTs) ranging from 2 to 8 days using an organic loading rates ranging 333–65 kg $$ {\text{BOD}}_{5} $$ /ha/day using two HRAPs, 250 and 300 mm deep, respectively. In this experiment, Chlorella sp., Chlamydomonas sp., and Scenedesmus sp., the class of Chlorophyceae, were identified as the dominant species. Chlorophyll-a production was higher in the shallower ponds (250 mm) throughout the course of the study, whereas the deeper HRAP (300 mm) showed better dissolved oxygen production. The maximum COD and $$ {\text{BOD}}_{5} $$ removal of 78.03 and 81.8% was achieved at a 6-day HRT operation in the 250-mm-deep HRAP. Therefore, the 300-mm-deep HRAP is promising for scaling up organic pollutant removal from municipal wastewater at a daily average organic loading rate of 109.3 kg $$ {\text{BOD}}_{5} $$ /ha/day and a 6-day HRT. We conclude that the removal of organic pollutants in HRAP can be controlled by pond depth, organic loading rate, and HRT.

In spite of considerable progress made in the prevention and control of schistosomiasis and other snail-borne diseases, transmission has intensified in some endemic areas as a result of land-use and climate changes. We used decision tree models and multivariate analysis to identify factors affecting the occurrence and abundance of medically important freshwater snail intermediate hosts in the Omo-Gibe river basin, Ethiopia. The models were based on a dataset of 140 samples collected from lakes, wetlands, rivers, dam reservoir shores and irrigation canals. A total of 1866 freshwater snails belonging to four genera and seven species were collected. Biomphalaria pfeifferi, Lymnaea natalensis and Bulinus globosus had fair to moderate predictive performance based on Kappa statistics (ĸ > 0.2), indicating that these species have clear environmental requirements within the habitat gradient studied. The most important variables influencing the abundance and occurrence of snail species were the presence of predator and competitor, canopy cover, type of water body, waste dumping and water pH. In conclusion, snail species occurred less frequently and in smaller numbers in water bodies with minimal human disturbances. Therefore, preventing human disturbance in water bodies may enhance aquatic biodiversity, thereby increasing the abundance of snail predators and competitors. Preventing the pollution of these ecosystems is essential to maintain their ecological integrity and sustain the ecosystem services they provide to local communities.

Eutrophication due to uncontrolled discharge of sewage water rich in nitrogen and phosphorous is one of the most significant water quality problems world-wide. Nitrogen and phosphorous can be removed by activated sludge process, one of the widely applied technologies among other conventional methods for municipal wastewater treatment. However, such technology requires high capital and operational costs, making it unaffordable for many developing nations, including Ethiopia. This study aimed to investigate the performance of two high rate algal ponds (HRAPs) in nitrogen and phosphorous removal from primary settled municipal wastewater under high land tropical climate conditions in Addis Ababa. The experiment was run under semi-continuous feed for 2 months at hydraulic retention times (HRT) ranging from 2 to 8 days and organic loading rates ranging from 44.3 to 9.08 g COD/m2/day using two HRAPs 250 and 300 mm deep, respectively. In this experiment, Chlorella sp., Chlamydomonas sp., and Scenedesmus sp. in the class of Chlorophyceae were identified as the dominant species. The maximum TN and TP removal of 91.70 and 82.81% was achieved in the 300 mm deep HRAP during 8 and 6 day HRT operations, respectively. Increased HRT and pond depth increased nutrient removal but high chlorophyll-a biomass was observed in the 250 mm deep HRAP. Therefore, the 300 mm deep HRAP is promising for scaling up nutrient removal from municipal wastewater at a daily average organic loading rate in the range of 14.3–15.33 g COD/m2/day or 10.34–11.46 g BOD5/m2/day and a 6 day HRT. We conclude that HRAP is a dependable approach to remediate nitrogen and phosphorous from primary settled municipal wastewater in Addis Ababa climate with appropriate control of pond depth, organic loading rates and HRT.

This study aimed to investigate the physicochemical properties of sugar industry and ethanol distillery wastewater and the treatment of the blended wastewater through a two-stage anaerobic reactor. For this treatment, different initial chemical oxygen demand (COD) concentrations (5-20 g/L) and hydraulic retention times (HRTs) (2-10 days) were applied. The sugar industry effluent characteristics obtained in terms of organic matter (mg/L) were as follows: 5 days biochemical oxygen demand (BOD

Three pilot horizontal subsurface flow constructed wetlands (HSSFCWs) were constructed, covered with a geomembrane and filled with gravel media. The study compared the performance of the three pilot HSSFCWs, two planted with Vetiveria zizanioide and Phragmite karka, and one without plants, and all containing aeration facilities in treating municipal wastewater. HSSFCWs were loaded at a hydraulic loading rate of 0.025 m/d and a maximum organic loading rate of 6.16 g BOD/m2d with a hydraulic retention time of 6 days. Results show that V. zizanioide had better removal efficiencies (TSS: 92.3%; BOD5: 92.0%; PO4 3−: 86.7%) than P. karka (TSS: 91.3%; BOD5: 90.5%; PO4 3−: 85.6%), whereas P. karka showed better removal efficiency of NH4 + (86%), NO3 − (81.8%) and SO4 2− (91.7%) than V. zizanioide (NH4 +: 83.4%; NO3 −: 81.3%; SO4 2−: 90.5%). Removal rates in unplanted CWs were lower for all parameters: TSS (78%), BOD5 (73%), NH4 + (61.0%), NO3 − (55.5%), PO4 3− (67.6%), SO4 2− (78.1%). Higher removals of total coliform (3 log units) and Escherichia coli (2.4 log units) were obtained in the HSSFCW with plants compared to unplanted units (total coliform: 1.9 log units; Escherichia coli: 1.2 log units). Based on these findings, the treated water can be directly disposed into surface water bodies or used for irrigation as the concentrations of the pollutants are below the standard permissible limits of effluent discharge set by EEPA and WHO. Therefore, both V. zizanioide and P. karka are good candidates for remediation of wastewater by a constructed wetland system.

In Ethiopia, sugarcane estate farms and bioethanol distilleries are being expanded at an alarming rate to provide alternative sustainable energy as renewable, affordable, and low carbon footprint bioenergy for the transportation sector. The promotion of bioethanol production is definitely poised to cause high competition for water resources. Thus, the aim of this study was to investigate the water footprint (WF) of sugarcane molasses-based bioethanol production of the Metahara sugarcane farm. Ten years of meteorological data (2007–2016) were collected from the Metahara weather stations and processed through the CROPWAT 8 model using the Penman-Monteith method. Sugarcane coefficient (K c ) was taken from FAO data; and sugarcane growing seasons, fertilizer application rates, sugarcane yield, and factory data were obtained from the Metahara factories. Reference evapotranspiration varied from 4.73 to 7.98 mm/day whereas effective rainfall (R eff) values ranged from 256.4 to 743.6 mm/growing season of sugarcane (16 months). The estimated sugarcane water requirement (SWR) ranged from 2544.1 to 4833.3 mm/growing season. The ANOVA test (p > 0.05) for R eff showed statistically insignificant differences in means but the test for SWR (p

Water is becoming a scarce resource in terms of quantity and quality. Water supply enhancement measures are being taken with less attention given to wastewater management, leading to increased discharge of untreated wastewaters. Wastewater is emerging as an affordable and reliable alternative water supply for urban agriculture, supporting thousands of farmers. Extensive use of untreated wastewater for irrigation will without a doubt lead to accumulation of heavy metals in soils and crops, resulting in overwhelming risks to both public health and the environment. This paper deals with determination of the strength and compositions of the wastewater from a public university in the tropical semiarid region for rainy and dry seasons, based on a number of key parameters including heavy metals. Furthermore, it identified the real advantages of treated water use and issues pertaining to untreated wastewaters use for irrigation purposes. An independent t test showed significant differences in concentrations of all the tested metals, excluding lead, copper, and cadmium during dry and wet seasons. Similarly, differences were significant for electrical conductivity, biological oxygen demand, total nitrogen and total phosphorus. Salinity and concentrations of organics, nutrients, copper, cadmium, iron, manganese and to some extent copper exceeded the allowable thresholds for irrigation water. Lead, zinc, nickel and chromium, on the other hand, were lower than their respective limits. Wastewater used for irrigation purposes is unsafe, and urgent policy interventions on the use of untreated wastewater are required.

Background In Ethiopia, most women do not make the minimum number of antenatal care (ANC) visits recommended by WHO. This study modeled predisposing, enabling, need, and external environmental factors in the utilization of decentralized health facilities for ANC services in rural western Ethiopian communities. Methods A community-based, cross-sectional study was conducted in Gida Ayana Woreda (District) among 454 women. Data were collected through structured questionnaires. Multinomial logistic regression was used to model the association between the explanatory variables and the use of recommended and fewer than recommended visits for ANC with reference to the base model, no ANC visits. Results Only 15.2% of women made the recommended minimum number of ANC visits. Women with fewer than 2 children (AOR 10.7; 95% CI 3.0–8.4) were 10.7 times more likely received ANC service as recommended. Women with a delivery of 2 or more (AOR 9.7; 95% CI 3.7–5.2) home visits by health extension workers (HEWS) were 9.7 times more likely receiving minimum ANC services. Involvement in gainful activities had 4 times higher log odds of seeking recommended ANC (AOR 4.0; 95% CI 1.4–11.7). Women who experienced high fever were more likely to obtain the recommended ANC services (AOR 7.1; 95% CI 2.9–7.5). Residents of Ayana Kebele decentralization entity were 60% more likely to make the recommended number of visits to ANC (AOR 24.6; 95% CI 4.8–15.2). Conclusions Number of children, home visits, gainful activities, monthly income, high fever, and decentralized administrative kebele were strongly linked with recommended ANC schedule. The need for a program intervention aimed at meeting WHO recommendations for ANC visits include economizing birth size and spacing; improving home attendance by HEWs, knowledge of pregnancy complications and benefits of minimum ANC visits, local socio-economic development measures targeting poor women/households; further decentralization of health system improving proximity to ANC in rural western Ethiopia.

Background Despite substantial global effort and updated clinical management guidelines, diarrhea continues to be among leading worldwide causes of morbidity and mortality in children. Infectious diarrhea, the most common form of diarrhea causes substantial morbidity and mortality among children in developing countries, and the muddled use of antibiotics needs caution due to potential problems of drug-resistance. The aim of this study is to identify etiologies of diarrhea and drug susceptibility patterns of bacterial isolates in under-five children in refugee camps in Gambella Region, Ethiopia. Methods An institution- based matched case control study was conducted using a questionnaire-based interview from June to December 2017 in Pugnido and Teirkidi refugee camps. Stool samples were collected and parasites causing diarrhea were identified by wet mount microscopy. Conventional culture supplemented with API 20E identification kit was used to identify Salmonella and Shigella species. Antibiotic susceptibility of bacterial isolates was investigated by using the disk diffusion method. The association between etiologies and diarrhea was analyzed using McNemar test or Fisher exact test with 95% confidence interval at a level of significance of P . Results The overall prevalence of enteric pathogens were 55 (41.0%) in diarrhea cases and 18 (13.4%) in healthy controls. The detected etiologies include Giardia lambia (28), Shigella spp. (16), E. hystolyotica/dispar (13), Ascaris lumbricoides (10), Salmonella spp. (6), Cryptosporidium parvum (6), Hymenolepis nana (4) and Isospora belli (3). All isolates were sensitive to kanamycine and ceftazidime. The high resistance rate was observed against ampicillin (100%), amoxicillin (100%), erythromycin (52%), chloramphenicol (47.5%), tetracycline (40.5%), cotrimoxazole (34.8%) and amoxicillin-clavulanic acid (33%). The majorities of the isolates had a low rate of resistance to ciprofloxacin (8.7%), naldxic acid (8.7%) and amikacin (13%). Conclusions Giardia lamblia, E. Hystolytica/dispar, and Shigella spp are the common etiologies of diarrhea in children in the studied refugee camps. The study also showed that significant numbers of bacterial isolates were resistant to the commonly used antimicrobial drugs. Therefore, improving clinical laboratory services and promoting evidence-based drug prescription may reinforce proper use of antibiotics and reduce the emergence of microbial resistance.

Background Determination of infection rates of snail populations is one of the basic tools for epidemiological studies of snail borne diseases. In this study, we opted to determine the trematode infection of freshwater snails in the Omo-Gibe River Basin, southwest Ethiopia. Methods We collected snail samples from 130 observation sites in lakes, wetlands, rivers, reservoirs and irrigation canals surveyed during the dry season (March to May) in 2016. The snail samples were examined for trematode infections by cercarial shedding immediately after collection. Habitat conditions, water quality, human water contact practices and other human activities were assessed at each survey site. A redundancy analysis (RDA) was used to examine the relationship between cercarial infection and environmental variables. The statistical significance of eigenvalues and cercariae-environment correlations generated by the RDA were tested using Monte Carlo permutations at 499 permutations. Results A total of 3107 snails belonging to five species were collected. The most abundant species was Biomphalaria pfeifferi, representing 66% of the total collection. Overall, 109 (3.6%) of the snails were found infected with trematodes (cercariae). Biomphalaria pfeifferi was found to be the most highly infected, accounting 85% of all infected snails. A total of eight morphologically different types of cercariae were recorded, which included: Echinostoma cercariae, brevifurcate apharyngeate distome cercariae, amphistome cercariae, brevifurcate apharyngeate monostome cercariae, xiphidiocercariae, longifurcate pharyngeate distome cercariae, strigea cercariae and unidentified cercariae. Brevifurcate apharyngeate distome cercariae, and Echinostoma cercariae were the most abundant cercariae, accounting for 36 and 34% of all infection, respectively. The mean concentration of water conductivity and 5 days biological oxygen demand were higher in irrigation canals and lake sampling points. Human activities such as open field defecation, urination, livestock grazing, farming, and swimming were highly correlated with trematode infection. Conclusions The abundance, occurrence and infection rates of snail species were largely influenced by water physicochemical quality, sanitation and water contact behaviour of the inhabitants. Human activities, such as open field defecation and urination, livestock grazing, farming, and swimming were important predictors of the abundance of cercariae. Therefore, awareness creation should be implemented for proper containment of excreta (urine and faeces) and reducing human and animal contacts with surface waters to reduce snail-borne disease transmission.

Background Malaria remains a major public health problem in Ethiopia. The use of LLINs is an effective approach to reducing transmission. Persistent use of LLINs is determined by numerous factors. Quantitative studies have assessed LLIN ownership and utilization, but the behavioral, socio-cultural, socioeconomic and net distribution contexts that impact their use have not been examined in depth. This study aimed to explore barriers of persistent LLIN use among communities around Lake Tana. Methods Twenty-three community residents who owned LLINs (15) or not (8) during the study period and 38 key informants were interviewed from April to June 2017. Phenomenological study was employed to explore the local contexts and factors that influence persistent use of LLINs. Individuals were purposefully selected to capture different views. Community residents were selected based on their permanent residence and LLIN use experience. Key informants were health extension workers, local leaders, students, and health professionals. The data were managed using QSR International NVivo Version 10 software and coded, and themes were identified. Results Killing ability of nets against arthropods other than mosquitoes reportedly made use of LLINs a favored malaria prevention method despite their ineffectiveness after 3 months. Conical nets were preferred due to their compatibility with varied sleeping structures. Numerous factors influenced persistent use, notably erroneous perceptions about LLINs, malaria and mosquitoes; bedbug infestation; inconvenience; unintended uses; distribution problem of nets; and socio-cultural and economic factors. Unintended uses were often associated with local needs and seldom linked with social issues and deficiencies in information about malaria and LLINs. Collateral benefits were considered important, principally in terms of disinfestation of bedbugs. Conclusions Non-persistent LLIN use was associated with inconvenient bed net design and early damage; non-potency of the insecticide against other arthropods; facilitation of bedbug infestation; unintended uses; wrong perceptions about malaria, mosquitoes, and LLINs; and inadequate follow-up regarding LLINs utilization. Distribution of conical nets and provision of adequate information on LLINs and malaria may promote persistent use. Using an insecticide that also kills arthropods other than mosquitoes may reduce unintended uses and increase persistent use.