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Abstract Improving maternal and perinatal outcomes can be achieved by identifying factors affecting successful vaginal delivery following induction of labor, particularly in developing countries with low rates of induction. Besides this, evidence regarding the magnitude of successful vaginal delivery following induction and associated factors is limited in Ethiopia. Therefore, this study aimed to assess the magnitude of vaginal delivery following induction and associated factors among laboring women at South Wollo Zone Public Hospitals of Ethiopia, 2023. An institutional-based cross-sectional study was conducted among 385 from April 1 to June 15, 2023. A systematic random sampling method was used to select each participant. A pretested structured interviewer-administered questionnaire and checklist were used to collect data. Epi-Data version 4.6 and SPSS version 26 software were used for data entry and analysis, respectively. Multivariable binary logistic regression was used to identify associated factors and an adjusted odds ratio with a 95% confidence interval was used to identify significant variables. Model fitness was checked using the Hosmer-Lemeshow goodness of fit test. The study reported that 75.6% of participants gave vaginal delivery following induction with a 95% CI (71.00-79.80). Mid-upper arm circumstance 23–28 cm (AOR = 2.55, 95% CI: 1.19–5.47), multiparty (AOR = 3.01, 95% CI: 1.430–6.33), favorable bishop (AOR = 3.79, 95% CI: 1.74–8.26), oxytocin with cervical ripening method (AOR = 3.74, 95% CI: 1.99–7.04), and birth weight less than 4000gram (AOR = 5.40, 95% CI: 1.54–18.91) were factors significantly associated with successful vaginal delivery following induction. Therefore, obstetric caregivers should consider pre-induction assessments such as bishop score of the cervix and fetal weight estimation and improving the nutritional status of pregnant women.

Abstract The textile industry uses a lot of adhesives to join materials together, and many of these adhesives use petroleum-based ingredients that are harmful to the environment. To replace petroleum-based adhesives with a more environmentally friendly option for the textile industry, this study set out to create and evaluate a hot-melt adhesive derived from cassava starch. By adding kaolin clay as a filler and tannin as a tackifier in different ratios of starch, the created adhesive was enhanced. Tannic acid to starch ratios of 2:1, 6:1, and 10:1 w/w and kaolin to starch ratios of 3:1, 5:1, and 7:1 w/w were used to investigate the effects of clay and tackifier, respectively. The adhesives’s viscosity, moisture content, tensile strength, and shear strength were then measured. The presence of kaolin and tannic acid in starch-based adhesives favored a good interaction between the adhesive’s ingredients. The adhesive’s maximum shear strength was measured at 4.93 ± 0.11 Mpa when dry and 0.263 ± 0.21 Mpa when wet. The current data indicate that the optimal tensile strength was determined to be 3.45 ± 0.22 MPa. This result showed that hot melt adhesives based on cassava starch would be a good environmentally friendly substitute for petroleum-based adhesives, and more study in this field is necessary.

PLA/Sisal hybrid composites have been used in cars and technical textile applications. When utilized in composites, 3-D-printed PLA layers can improve performance and homogeneity. The primary goal of this research was to use sisal and 3-D-printed polylactic acid (PLA) layers to develop a sustainable bio-composite. To enhance the bonding of sisal fibres with the PLA matrix, sisal fibres were given a sodium hydroxide treatment. This would improve the mechanical and thermal properties of composites. Sisal fibre (between 4 wt% and 8 wt%), epoxy concentration (between 85 wt% and 90 wt%), and PLA 3-D printing infilling percentage (between 90 wt% and 100 wt%) were the independent parameters. The Taguchi L8 orthogonal array design was used to make the composite samples. The changes in the amounts of PLA infill, epoxy matrix concentration, and sisal fibre content were considered for test sample development. The optimal settings for improving their tensile, flexural, and impact capabilities were determined by analyzing their signal-to-noise ratio (S/N). The PLA/sisal fibre composite showed a remarkable level of mechanical properties in Sample 8, surpassing those of the other samples. To improve mechanical and thermal properties, the appropriate values for sisal fibre composition, PLA infilling percentage, and epoxy concentration percentage were 8 per cent, 95 per cent, and 85 per cent, respectively. After testing, the tensile (293–295.4 Megapascal) (Mpa), impact (2.73–4.84 Mpa), and flexural strength (188.5–270.4 Mpa) results show that the new composite has better mechanical behaviour properties. Additionally, FTIR, SEM, and DSC experiments were run to examine the composite's structural characteristics. Using less volatile epoxy resin, a sustainable 3-D-printed PLA layer and Sisal fibre bio-composite were developed.

Introduction: Depressive disorder is a common mental health issue among perinatal mothers living with HIV, potentially leading to significant despair and anxiety. This condition can hinder maternal-infant bonding and undermine efforts to prevent mother-to-child transmission of HIV. Despite its importance, little is known about the factors associated with depression in this population. Main objective: This study aimed to evaluate the prevalence and risk factors of perinatal depression among women living with HIV in the Amhara region, Northwest Ethiopia, in 2022. Methods: An institutional-based cross-sectional study was conducted among 399 HIV-positive pregnant and postpartum women, both with follow-up and newly diagnosed cases, who attended PMTCT services in the East Gojjam Zone Public Hospitals from May 28 to July 12, 2022. Participants were selected using a simple random sampling technique. Data were collected through direct interviews and document reviews. The Edinburgh Perinatal Depression Scale was used to assess perinatal depression which demonstrated high internal reliability (Cronbach's alpha of 0.93). Data were cleaned and analyzed using Epi-data version 3.1 and SPSS version 25. Binary logistic regression models were used to identify variables associated with perinatal depression, with statistical significance set at p

Ethiopia is among the East African regions with huge geothermal energy potential due to the presence of geologically active volcanic and hot spring-featured Rift Valley. However, geothermal energy is at its infant stage of utilization not only in Ethiopia but also in the continent of Africa and globally. Regionally, Kenya is the country with advanced extraction of it for electricity generation followed by Ethiopia in East Africa. Generation of electricity from this largely abundant energy resource has an enormous opportunity for societal and regional economic development though it is not an easy process due to the many challenges of the generation process. In this paper, geothermal energy in Ethiopia and the region, the opportunity, barriers with possible solutions, and future perspective are stated.

Abstract Despite remarkable progress in the reduction of under-five mortality; perinatal mortality is the major public health problem in Africa. In Ethiopia, the study findings on perinatal mortality and its predictors were inconsistent. Therefore, this systematic review and meta-analysis estimated the pooled perinatal mortality, and its association with antenatal care visit, maternal tetanus toxoid immunization, and partograph monitoring. International databases like PubMed, SCOPUS, Google Scholar and Science Direct were systematically searched. I squared statistics was used to determine the levels of heterogeneity across studies and the pooled estimate was computed using a random-effect model. The meta-analysis showed that a pooled prevalence of perinatal mortality in Ethiopia was 6.00% (95% CI 5.00%, 7.00%). The highest proportion of perinatal mortality was a stillbirth, 5.00% (95% CI 4.00%, 7.00%). Women who had antenatal care visit [OR = 0.20 (95% CI 0.12, 0.34)], maternal tetanus toxoid immunization [OR = 0.43 (95% CI 0.24, 0.77)] and partograph monitoring [POR = 0.22 (95% CI 0.06, 0.76)] reduced the risk of perinatal mortality. Whereas, previous history of perinatal mortality [POR = 7.95 (95% CI 5.59, 11.30)] and abortion history (POR = 2.02 (95% CI 1.18, 3.46)) significantly increased the risk of perinatal mortality. Therefore, antenatal care visit, maternal tetanus toxoid vaccination uptake, and partograph utilization should be an area of improvements to reduce perinatal mortality.

Objectives: This study assessed the non-utilization of PNC services, identified factors associated with PNC non-utilization, and explored barriers to PNC utilization in the rural community. Method: A community-based mixed-cross-sectional study was conducted from 20 March to 20 April 2020 among 521 women who gave birth in the last 12 months prior to this survey. A multistage sampling and face-to-face interview techniques were used for the quantitative data collection, and a purposive sampling technique was used to select the study participants. In-depth interviews were used for the qualitative data collection. The quantitative data were entered into EpiData version 3.1 and then exported to SPSS version 25 for analysis. A binary logistic regression analysis was used to test the association between the independent and outcome variables. A p -value of

Background. Continuum care is a basic package approach for women to receive essential services throughout pregnancy, childbirth, and postpartum, and it is critical for women and their infants’ survival and well-being. Although it is an effective strategy for improving maternal and child health, it has not been implemented adequately in less developed countries, primarily in sub-Saharan Africa, including Ethiopia, where 55% of women have been dropped out from the continuum of care. Therefore, this study is aimed at assessing maternity continuum care completion and its associated factors within northwest Ethiopia, 2020. Materials and Methods. A community-based cross-sectional study design was considered among 504 women from March 10 to March 30, 2020, using pretested and structured questionnaires administered via face-to-face interviews. To select study participants, a simple random sampling technique was used. Data were coded, checked, and entered into EpiData software (V. 4.2), then transferred to SPSS (V. 25) for further analysis. A bivariable analysis with 95% CI was performed, and variables with P 0.25 during binary logistic regression were entered into a multivariable analysis to assess predictors’ independent effect. Results. About 177 (37.6%) women completed maternal continuum care. Women with secondary education and above (AOR=2.75, 95% CI 1.42-5.32), urban residence (AOR=2.45, 95% CI 1.35-4.45), using ambulance transport (AOR=3.96, 95% CI 2.19-7.19), mass media exposure (AOR=3.64, 95% CI 2.02-6.56), and distance from health facilities (AOR=3.22, 95% CI 1.84-5.63) showed significant positive associations with completion of maternity continuum care. Conclusion. However, a higher proportion of mothers completed the continuum of maternity care in the district than Ethiopian Demographic and Health Survey 2016 (9.1%); further interventions are compulsory to reach the acceptable level. Hence, comprehensive awareness-raising, education, and promotion activities at the community and health facility levels and empowering women in health care and decision-making backing to expand the completion of maternity continuum of care are necessary.

Background. Intestinal parasite infections are among the most common infections worldwide. They pose a high burden in pregnant women in developing countries causing maternal anemia, low birth weight, and prenatal mortality. This study is aimed at assessing intestinal parasite infection prevalence, species diversity, and associated factors among pregnant women. Methods. A community-based cross-sectional study was conducted among pregnant women in Debre Elias district from March 2021 to July 2021. Three hundred sixty-three study participants meeting the inclusion criteria were enrolled for the study, and all submitted the required amount and quality of stool specimen. Immediately after collection, macroscopic (gross) and microscopic (saline wet mount) examination of stool sample was performed to detect and identify intestinal parasites. The generated data were checked for completeness, coded, entered, and analyzed using SPSS version 20.0 (SPSS Inc., Chicago, 2011) software. Binary logistic regression was applied to show significant association between dependent and independent variables. Statistically significant association was declared at a P value of < 0.05. Result. Of the study participants screened for intestinal parasite, 43.5% (158/363) were infected with at least one intestinal parasite. From the total positives, 40.5% (147/363) were mono and 3.0% (11/363) were double infections. Five intestinal parasite species were recorded, of which hookworm was the predominant, (65.2%, 103/158) followed by E. histolytica/dispar (12.7%, 20/158) and G. lamblia (11.4%, 18/158). Ascaris lumbricoides and Taenia species comprised the least percentage (1.9%, 3/158 each). Source of drinking water and occupation were identified as significant factors associated with intestinal parasite infection. Farmer pregnant women were 6.41 times (AOR=6.41, 95% CI: 1.05-39.16; P=0.034) more likely to be infected by intestinal parasites than their counterparts. Pregnant women who drank tape water were 0.52 times less (AOR=0.52, 95% CI: 0.30-0.88; P=0.017) likely to be infected by intestinal parasites. Conclusion. Intestinal parasite infections remained a serious health burden to pregnant women in the study area with the dominance of a hematophagous worm (hookworm). Community-based intestinal parasite screening and treatment are essential to alleviate the burden caused by intestinal parasite infections.

BackgroundThe days and weeks after childbirth are crucial for both the mother and her newborn child leading for the majority of maternal and perinatal mortalities. The World Health Organization recommends at least three postnatal visits within 42 days after birth. However, postnatal care utilization remains low worldwide. Quantitative findings revealed low utilization of postnatal care in Ethiopia, however, no study explored the barriers for postnatal care. This study aimed to assess the barriers to postnatal care service utilization in East Gojjam Zone, Northwest Ethiopia.MethodsA community-based, mixed type cross-sectional study was conducted from December 15, 2018, to February 15, 2019. The quantitative data was gathered using the interviewer-administered interviewing technique from 751 women who gave birth within one year prior to the study selected by multistage sampling. The qualitative data were collected from purposively sampled women, facility leaders, and health extension workers using in-depth interviews and focused group discussions. The quantitative and qualitative data were analyzed using logistic regression and by the thematic content analysis method, respectively.ResultsThe study revealed that postnatal care service utilization was 34.6%. The odds of using PNC services were greater in women aged 25-34 years and used maternity waiting home. In contrast, women who were muslim religion followers, had normal or instrumental birth, not aware of the PNC services and whose partners were not supportive of the use of MCH services were less likely to use PNC services. According to the qualitative findings, lack of awareness, traditional beliefs and religious practices, distance and transportation, environmental exposure, and waiting time were identified as barriers to PNC service utilization.Conclusion and recommendationThe study showed low utilization of PNC services in East Gojjam zone, northwest Ethiopia. Improvements in personal health education, in construction of relevant infrastructure, and to transport, are needed to remove or reduce barriers to PNC service use in East Gojjam Zone, Northwest Ethiopia.

Abstract Background Postpartum maternal morbidity is maternal illness that occurs after one hour of expulsion of placenta up to six weeks of childbirth. Though the true burden of this problem is not well known estimates of WHO, UNICEF and UNFPA showed that 1.4 million women experience acute obstetric morbidity annually. Knowledge of magnitude and predicting factors postpartum morbidity is central to understand the extent of the problem and will help as a cornerstone in designing and implementing better preventive strategies. Objectives To assess the magnitude and factors associated with postpartum morbidity in public health institutions in Debre Markos town. Method Institutional based cross sectional study was conducted in Debre Markos town public health institutions by reviewing delivery charts, delivery records and reporting log books. Total deliveries in each health institution in the previous year were identified and number of records to be included from each institution was determined by probability proportion to size. Systematic sampling technique was employed to select 308 charts for review. Data was collected by trained midwifes using structured checklist; entered by epi info and analyzed using SPSS 20. To present findings descriptive statistics using frequencies, charts and figures were used accordingly. Finally binary and multiple logistic regressions were performed to identify predicting factors. Results The magnitude of postpartum morbidity was found to be 101(32.8%). Divorced/widowed women [AOR = 10.920, 95% CI: (2.168, 54.998)], women who didn’t have ANC follow up [AOR = 3.710, 95% CI: (1.749, 7.870)], abnormal labour [AOR =3.496, 95% CI: (1.69, 7.22)], women delivered by doctor [AOR =0.111, 95% CI: (0.027, 0.454)] and women who were not attended postpartum visit [AOR =0.088, 95% CI: (0.040, 0.194)] were the factors associated with postpartum maternal morbidity. Conclusion Maternal morbidity in Debre Markos health institution was found to be major maternal health issue. Being divorced/widowed, absence of ANC visit, intrapartum abnormalities, delivery attended by skilled professionals and no post-partum visit were important predictors of maternal postpartum morbidity.

BackgroundAlthough antiretroviral therapy (ART) significantly improves the survival status and quality of life among human immunodeficiency virus (HIV)-infected children, loss to follow-up (LTFU) from HIV-care profoundly affecting the treatment outcomes of this vulnerable population. For better interventions, up-to-date information concerning LTFU among HIV-infected children on ART is vital. However, only a few studies have been conducted in Ethiopia to address this concern. Thus, this study aims to identify the predictors of LTFU among HIV-infected children receiving ART at Debre Markos Referral Hospital.MethodsAn institution-based retrospective follow-up study was done among 408 HIV-infected children receiving ART at Debre Markos Referral Hospital between 2005 and March 15, 2019. Data were abstracted from the medical records of HIV-infected children using a standardized data abstracted checklist. We used Epi-Data Version 3.1 for data entry and Stata Version 14 for statistical analysis. The Kaplan-Meier survival curve was used to estimate the survival time. A generalized log-rank test was used to compare the survival curves of different categorical variables. Finally, both bi-variable and multivariable Cox proportional hazard regression models were used to identify the predictors of LTFU.ResultsOf 408 HIV-infected children included in the final analysis, 70 (17.1%) children were LTFU at the end of the study. The overall incidence rate of LTFU among HIV-infected children was found to be 4.5 (95%CI: 3.5-5.7) per 100-child years of observation. HIV-infected children living in rural areas (AHR: 3.2, 95%CI: 2.0-5.3), having fair or poor ART drug adherence (AHR: 2.3, 95%CI: 1.4-3.7), children started ART through test and treat approach (AHR: 2.7, 95%CI: 1.4-5.5), and children started protease inhibiter (PI)-based ART regimens (AHR: 2.2, 95%CI: 1.1-4.4) were at higher risk of LTFU.ConclusionThis study found that one in every six HIV-infected children lost form ART follow-up. HIV-infected children living in rural areas, having fair or poor ART drug adherence, started ART based on test and treat approach, and taking PI-based ART regimens were at higher risk of LTFU.

Background. Low birth weight is defined as a live born infant weighs less than 2 500 g regardless of gestational age. Globally, the prevalence of low birth weight ranges from 3% to 15%. Birth weight plays an important role in infant mortality, morbidity, development, and future health. The prevalence of low birth weight in Ethiopia was estimated to be 14% which is one of the highest percentages in the world. So, the aim of this study is to assess magnitude and associated factors of low birth weight among newborns delivered at Dangla Primary Hospital, Amhara Region, Ethiopia. Methods. An institution-based cross-sectional study was conducted at Dangla Primary Hospital from September 27 to June 10, 2017. Systematic random sampling technique was used to select the 232 study participants. A structured and pretested questionnaire was used to collect data. Data quality was assured by pretesting, training, and frequent supervision. Descriptive statistics were performed for the descriptive part of the study. Binary and multiple logistic regression analyses were conducted to identify independent predictors of low birth weight. Those variables and p-value < 0.25 were included in the multivariable logistic regression for controlling the possible effect of confounders. Finally, variables which had significant association were identified on the basis of AOR, with 95%CI and with P-value

Lymphatic filariasis (LF) and onchocerciasis (OV) are among the neglected tropical diseases (NTD) targeted for elimination in Ethiopia. We used a transmission assessment survey (TAS-1) to evaluate the serological status of OV in three co-endemic districts in Gambella simultaneously. During May and June 2019, blood samples were collected from 6- to 7-year-old children who were randomly selected through standard community-based TAS methodology. Children were tested for both circulating filarial antigen (CFA) for LF via filariasis test strip and for Onchocerca volvulus 16 (Ov16) antibody for OV via laboratory-based ELISA. A total of 3,377 children from 150 villages in the three districts were tested; 1,823 (54.0%) were male. All three districts had CFA results below the critical threshold for stopping LF mass drug administration (MDA). In contrast, 40 children (1.2%) were positive for Ov16 antibody, well above the WHO's OV stop MDA threshold of 0.1%. The integrated assessment indicated two programmatic decisions: stop MDA for LF and continue MDA for OV. Accordingly, albendazole MDA was discontinued in the districts but ivermectin MDA continued. This integrated assessment showed that a random sample for TAS can give important information about OV transmission status in co-endemic areas.

At the current times, soil erosion is the major problem that affects land and water resources, especially in Ethiopia's highlands. Due to the dynamics of land use land cover change, land degradation, and soil erosion increase significantly and result in a loss of fertile soil every year and lead reduction in agricultural production. This study was therefore designed to explore the land use land cover (LULC) dynamics from 1986 to 2020, to estimate mean annual soil erosion rates and identify erosion hotspot areas from 1986 to 2020, and finally, to evaluate the impacts of land use land cover change on soil loss of 1986 to 2020. For this, Landsat imageries of 4 years from 1986 to 2020 were used. Maximum likelihood supervised classification methods were used to classify LULCs. The dynamics of LULC change were used as an input for measuring soil loss by employing the combination of geospatial technologies with the revised universal soil loss equation (RUSLE). The LULC maps of 1986, 1997, 2009, and 2020 were used for identifying crop management (C) factor and conservation practice (P) factor. Rainfall erosivity factor (R), soil erodibility factor (K), and slope length and steepness factor (LS) were also used as sources of data. Based on the five factors, soil erosion intensity maps were prepared for each year. Results showed that the annual soil loss in the watershed ranged from 0 to 3938.66 t/ha/year in 1986, 0 to 4550.94 t/ha/year in 1997, 0 to 5011.21 t/ha/year in 2009, and 0 to 6953.23 t/ha/year in 2020. The annual soil loss for the entire watershed was estimated at 36.889, 42.477, 47.805, and 48.048 t/ha/year in 1986, 1997, 2009, and 2020, respectively. The mean soil loss of 1986, 1997, 2009, and 2020 was higher in cultivated land followed by shrub land, grazing land, and forest land. Mean soil loss increased from 1986 to 1997, from 1997 to 2009, and from 2009 to 2020. This is because of the expansion of agricultural land at the expense of grazing land and shrub land. Therefore, urgent soil and water conservation practices should be made in hotspot areas., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Asthma stands 16 th among the leading causes of years lived with disability and 28 th among the leading causes of disease in the world. A metered-dose inhaler remains the principal route for drug administration, and it has greater advantages over systemic treatment. In routine use, however, a majority of patients make inhalation errors. Suboptimal inhaler technique worsens health outcomes, with poor disease control, and increases the risk of hospitalization. This study aimed to assess practice metered-dose inhalation techniques and associated factors among asthmatic patients at Debre Markos Comprehensive Specialized Hospital, East Gojjam, Amhara region, Ethiopia., Methods: Prospective cross-sectional study was conducted from July 15 to August 30, 2020. Data were collected through a semistructured questionnaire. The data were analyzed using SPSS version 25. Associations between dependent and independent variables were assessed by using binary and multiple logistic regressions. P values less than 0.05 were considered to be statistically significant in all cases. Results are presented in tables, figures, numbers, and percentages., Result: A total of 166 patients had involved in the study, of which 52.4% were females. One hundred and eleven (66.9%) participants had good knowledge of asthma and inhalational techniques, while the rest of them had poor knowledge. One hundred and eight (65.1%) patients had effective practice on metered-dose inhaler use techniques. Participant's knowledge regarding asthma and meter dose inhaler and marital status has a significant association with their practice of metered-dose inhaler techniques with P value 0.001 and 0.006, respectively., Conclusion: In this study, most participants are suffering from asthma for a long duration and they have repeated exacerbation. Around two-thirds of patients had good knowledge regarding asthma and metered-dose inhaler and practice on metered-dose inhaler techniques. Participants with poor knowledge had poor practice on metered-dose inhaler techniques, and single patients were less likely to have poor practice on metered-dose inhaler techniques. Health education and counseling services should be consistently provided to the clients regarding the proper steps of inhalers use., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Tadele Asmare et al.)

Background: Onchocerciasis transmission across international borders is not uncommon, yet a coordinated cross border stops mass drug administration (MDA) decision has not been documented., Methods/principle Findings: The Galabat-Metema focus involves neighboring districts on the border between Sudan and Ethiopia. Mass drug administration (MDA) was provided once and subsequently twice per year in this focus, with twice-per-year beginning in Ethiopia's Metema subfocus in 2016 and in the Sudan's Galabat subfocus in 2008. Ov16 ELISA-based serosurveys were conducted in 6072 children under 10 years of age in the Metema subfocus in 2014, and 3931 in the Galabat in 2015. Between 2014 and 2016, a total of 27,583 vector Simulium damnosum flies from Metema and 9,148 flies from Galabat were tested by pool screen PCR for Onchocerca volvulus O-150 DNA. Only 8 children were Ov16 seropositive (all in the Metema subfocus); all were negative by skin snip PCR. The upper limit of the 95% confidence interval (UCL) for Ov16 seropositive was <0.1% for the overall focus and 0.14 positive fly heads per 2000 (UCL = 0.39/2000). However, an entomological 'hotspot' was detected on the Wudi Gemzu river in Metema district. The hotspot was confirmed when 4 more positive fly pools were found on repeat testing in 2017 (1.04 L3/2000 flies (UCL = 2.26/2000). Information exchange between the two countries led to stopping MDA in a coordinated fashion in 2018, with the exception of the hotspot at Wudi Gemzu, where MDA with ivermectin was increased to every three months to hasten interruption of transmission., Conclusion: Coordinated stop MDA decisions were made by Sudan and Ethiopia based on data satisfying the World Health Organization's criteria for interruption of onchocerciasis transmission. Definitions of entomological 'hotspots' and buffer zones around the focus are proposed., Competing Interests: The authors have declared that no competing interests exist.