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Getu Ayele,1 Belayneh Getachew,1 Fufa Dawo Bari,2 Berecha Bayissa,1 Ayelech Muluneh,3 Takele Abayneh,1 Esayas Gelaye,1 Bedaso Mammo Edao2 1Research and Development Directorate, National Veterinary Institute, Bishoftu, Oromia, Ethiopia; 2Department of Microbiology, Immunology and Vet Public Health, College of Veterinary Medicine, Addis Ababa University, Bishoftu, Oromia, Ethiopia; 3Department of Microbiology, Animal Health Institute, Sebeta, Oromia, EthiopiaCorrespondence: Bedaso Mammo Edao, Email edaobedaso@gmail.comIntroduction: Foot-and-mouth disease is globally one of the most economically important viral diseases of cloven-hoofed animals that can be controlled by different strategies, where vaccination plays an important role. Selection of adjuvant added to vaccine preparation is crucial in ensuring the protective effect of the vaccine. Aluminum hydroxide gel mixed with saponin (AS) is widely used adjuvant, with its suboptimal immune response in FMD vaccine. The present study was undertaken to evaluate different ingredients of adjuvants for inactivated trivalent (A, O and SAT 2) FMD vaccine and to demonstrate the effect of booster dose in cattle.Methods: Cattle were grouped into five; four experimental and one control, with six animals in each group and immunized with trivalent vaccine with various formulations of adjuvants. Immune response was measured using Solid Phase Competitive Enzyme Linked Immune Sorbent Assay (SPCE).Results: The antibody level in cattle immunised with a vaccine formulation containing a mixture of aluminum hydroxide gel and saponin (AS) were significantly lower than AS boosted group for the three serotypes (p< 0.05, t-test), which directs the need for booster dose. Whereas the antibody response in the AS + oil group was higher followed by oil alone. The AS preparation with a booster dose has shown better immune response compared to the group without.Conclusion: The findings of this study could suggest that oil based and AS with oil could replace the conventional aluminum hydroxide gel and saponin adjuvants in FMD vaccine preparations. Challenge test was not successful indicating the need for further research on the virus infectivity.Keywords: adjuvant, foot and mouth disease, immune response, serotype

Abstract Background and Aims Malnutrition is one of the key factors in children's inappropriate physical and mental development. It is a significant issue that results in the deaths of 3.5 million children under the age of 5 every year worldwide. This study's primary goal was to pinpoint important family‐related causes of underweight child malnutrition in Ethiopia. Methods The data were gathered from the Central Statistical Agency's 2019 Ethiopian Demographic and Health Survey. Data were examined using descriptive statistics and an ordinal logistic regression model after the sample was chosen using a stratified, two‐stage cluster sampling approach. Results Overall 6101 underweight children were involved in the study of which 5019 (82.27%) were severely underweight, 28 (0.46%) were moderately underweight and 1054 (17.28%) were mild. The result showed that, birth order (p

Yirgalem Tola,1 Gistane Ayele,2 Negussie Boti,2 Manaye Yihune,2 Firdawek Gethahun,2 Zeleke Gebru2 1Arba Minch Health Science College, Department of Midwifery, Arba Minch, Ethiopia; 2Arba Minch University, College of Medicine & Health Sciences, School of Public Health, Arba Minch, EthiopiaCorrespondence: Negussie Boti Tel +251-920997752Email Hanehalid@gmail.comBackground: It is generally accepted that pregnancy and childbirth are natural physiological processes. However, these significantly affect the quality of mothers’ lives. Little is known about the level of quality-of-life and associated factors among postpartum women in Ethiopia, particularly in the study area.Methods: A community-based cross-sectional study was conducted among 409 randomly selected post-partum women who were living in Arba Minch town. Systematic random sampling was employed to select the study participants. The standard quality-of-life assessment tool which is known as the short-form SF 36 tool was used to assess health-related quality-of-life. The logistic regression model was used to identify associated factors. Statistically significant variables at a p-value< 0.25 in the bi-variable analysis were candidate variables for multi-variable analysis and statistical significance which was declared at a p-value< 0.05.Results: Among the study participants, 255 (62.3%) had lower level health-related quality-of-life (HRQoL). About 46.2% of the study participants had lower physical HRQoL and about 79% of the study participants had lower mental HRQoL. The overall mean score of HRQoL was 45.15 (± 8.13). Factors associated with lower overall HRQoL were age group 17– 24 years (AOR=2.73, 95% CI=1.22– 6.10), no formal education [AOR 2.02, 95% CI (1.05– 3.89)], and cesarean delivery (AOR=0.49, 95% CI=0.24– 0.97). A factor associated with lower physical HRQoL was cesarean delivery (AOR=0.34, 95% CI=0.13– 0.88). Factors associated with lower mental HRQoL were age group 17– 24 (AOR=3.37, 95% CI=1.60– 7.04), not receiving antenatal care (AOR=3.65, 95% CI=1.45– 9.16), and having postpartum depression (AOR=2.27, 95% CI=1.30– 3.93).Conclusion: The results suggest that the majority of post-partum women had a lower HRQoL, particularly women’s mental health was compromised. In this study, a suggestion is made that the respective bodies need to give particular attention to mothers during the post-partum period to prevent poor quality-of-life.Keywords: post-partum women, health-related quality-of-life

Agegnehu Bante,1 Abera Mersha,1 Azene Tesfaye,2 Behailu Tsegaye,3 Shitaye Shibiru,1 Gistane Ayele,4 Meseret Girma4 1School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 3School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 4School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, EthiopiaCorrespondence: Agegnehu BanteArba Minch University, PO Box 21, Arba Minch, EthiopiaTel +251-918-487-338Email agegnehubante@gmail.comIntroduction: COVID-19 is one of the huge general wellbeing crisis for the planet. Since its first recognition, over 90.2 and 1.9 million people are infected and dead, respectively. Although it is not easily available for low-income countries, after many trials vaccination is initiated by some industrialized nations. However, still now there is no effective treatment for the infection. Henceforth, adherence with COVID-19 preventive and control measures is the only option to stop its spread and minimize its disastrous impact, especially, in developing nations like Ethiopia. Knowledge and behavior change are pillars to engage with preventive measures. Thus, the motivation behind this study was to assess communities’ adherence with COVID-19 preventive measures and its associated factors among inhabitants of Dirashe district, Southern Ethiopia.Materials and Methods: A cross-sectional study was directed among 648 inhabitants in Dirashe district from June 20 to July 5, 2020. A multistage sampling technique was applied to select the participants. A pretested, validated and reliable interviewer-administered survey tool comprising the socio-demographic characteristics, knowledge (α = 0.78), and adherence with COVID-19 preventive measures (α = 0.73) was used. The data were assorted electronically using Open Data Kit (ODK) collect version 1.17.2 android application and exported to Stata version 15.0 for analysis. Adjusted odds ratio (aOR) with 95% CI was used to identify variables associated with the community’s adherence with COVID-19 preventive measures.Results: An aggregate of 644 inhabitants were participated in this study; of them, only 12.3% [95% confidence interval (CI): 9.8, 15.1] adhered to the recommended COVID-19 preventive measures. Likewise, 63.51% [95% CI: 59.7, 67.2] and 54.5% [95% CI: 50.6, 58.4] of the participants had good knowledge and favorable attitude towards COVID-19 preventive measures, respectively. Urban residence [aOR: 9.74, 95% CI: 4.72, 20.10], favorable attitude [aOR: 1.97, 95% CI: 1.05, 3.68] and concerned about COVID-19-related stigma [aOR: 2.43, 95% CI: 1.02, 5.79] were independently associated with communities adherence with COVID-19 preventive measures.Conclusion: In general, communities’ adherence to the recommended COVID-19 preventive measures was very low in the area. Addressing underprivileged population groups, disseminating teaching aids in local languages, behavioral change communications, and law enforcement is imperative to strengthen COVID-19 prevention practice.Keywords: coronavirus disease 2019, public adherence, knowledge, prevention practice, southern Ethiopia

Negussie Boti,1 Sultan Hussen,1 Gistane Ayele,1 Abera Mersha,2 Selamawit Gebeyehu,1 Mekidm Kassa,1 Tesfaye Feleke,1 Gebremaryam Temesgen3 1School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 2School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; 3Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, EthiopiaCorrespondence: Negussie Boti Tel +251-920-997-752Email Hanehalid@gmail.comBackground: Mental health disorders have identified as being one of the public health issues throughout the world. Recent evidence reveals that more than 21 million people diagnosed with schizophrenia. However, there is little information about community perception and attitude towards people with Schizophrenia in Ethiopia.Objective: The aim of this study was to assess the community perception and attitude towards people with Schizophrenia among residents of Arba Minch Zuria Districts, Southern Ethiopia.Methods: A community-based cross-sectional study was conducted among 617 randomly selected adults. Interviewer-administered standard tool was used to collect the data. Descriptive statistics like frequency, mean, and median computed. A binary logistic regression model used to identify factors affecting community perception and attitude towards people with schizophrenia.Results: Of the study population, 469 (76%) of respondents had good perception and 390 (63.2%) had positive attitudes towards people with schizophrenia. The study participants identified talkativeness and self-neglect behaviors as the most common manifestations of schizophrenia. Besides, this study identified substance misuse and head injury as the perceived cause and spiritual or traditional methods as a preferred treatment for people with schizophrenia. Moreover, the study participants preferred spiritual or traditional methods for the treatment of schizophrenia. Young age [AOR=2.03, 95% CI: 1.21, 3.40], females [AOR=2.32, 95% CI: 1.58, 3.41], good perception towards people with schizophrenia [AOR=4.95, 95% CI: 3.25, 7.54] and no formal educational status [AOR=2.75, 95% CI: 1.33, 5.70], and primary education [AOR=3.72, 95% CI: 1.87, 7.39] were significantly associated with the attitude towards people with schizophrenia.Conclusion: The findings of this study indicate that approximately one-third of the residents had unfavorable attitudes towards people with schizophrenia. Therefore, giving special attention to male, elders and those who were educated, and individuals who have poor perceptions of people with schizophrenia is crucial.Keywords: perception, attitude, schizophrenia, Arba Minch Zuria District, Southern Ethiopia

Abstract Background The newborn and infant continuum of care such as essential newborn care, early initiation and exclusive breastfeeding, and immunisation are highly recommended for improving the quality of life and survival of infants. However, newborn and infant mortality remains high across Sub-Saharan African countries. While unintended pregnancies are associated with adverse newborn and infant health outcomes, there is inconclusive evidence on whether pregnancy intention influences newborn and infant continuum of care completion. Therefore, this review aimed to pool findings reported in the literature on the association between pregnancy intention and newborn and infant health care across the continuum of care in Sub-Saharan Africa. Methods We searched MEDLINE Complete, EMBASE, CINAHL Complete, and Global Health databases for studies potentially eligible for this systematic review and meta-analysis. Two researchers independently screened the identified articles by abstract and title, and then full-text using Covidence. We used the Newcastle–Ottawa Scale to assess the quality of the included studies. The Cochran’s Q test and I2 were executed to detect and quantify the presence of statistical heterogeneity in the studies. Meta-analysis was done for each outcome when more than one original study reported relevant data, using Stata statistical software version 18. Results Eleven studies were included from a total of 235 articles identified by the search. The odds of completing essential newborn care (pooled odds ratio: 3.04, 95% CI: 1.56, 5.90), early initiation of breastfeeding (pooled odds ratio: 1.30, 95% CI: 1.13, 1.52), exclusive breastfeeding (pooled odds ratio: 2.21, 95% CI: 1.68, 2.89), and being fully immunised (pooled odds ratio: 2.73, 95% CI: 1.16, 6.40) were higher among infants born to women with intended pregnancies as compared to women with unintended pregnancies. Conclusion Intended pregnancy was positively associated with essential newborn care completion, early initiation and exclusive breastfeeding, and full immunisation of infants in SSA countries. Thus, policy-makers and stakeholders should strengthen the provision of quality family planning services to prevent unintended pregnancy. Furthermore, follow-up of women with unintended pregnancies is needed to increase women’s opportunity to access essential newborn health care services that further reduce the risk of newborn and infant morbidity and mortality. Systematic review registration PROSPERO registration number CRD42023409148.

Abstract Background Adverse perinatal health outcomes are notably high among African-born women living in Australia. This problem is partly attributed to their lower engagement in maternity care services as compared to Australian-born women. Various barriers might limit African-born women’s access to and use of services; however, these barriers are not well documented. Therefore, this review aimed to synthesise current qualitative evidence on barriers and facilitators of access to maternity care for African-born women living in Australia. Methods The search was conducted in MEDLINE, CINAHL, Embase, PsychInfo, and Maternity and Infant Care databases on 16 April 2023. All articles retrieved were meticulously screened for eligibility by two independent reviewers with any disagreements resolved through discussion. The quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Studies were screened in Covidence and analysed in NVivo. The findings were organised and presented using Levesque’s framework of healthcare access. Results Out of 558 identified papers, 11 studies comprising a total of 472 participants met the eligibility criteria. The review highlighted provider-side barriers such as shortage of information, unmet cultural needs, long waiting times, low engagement of women in care, discrimination, and lack of continuity of care. User-side barriers identified include communication issues, difficulty navigating the health system, and lack of trustful relationships with healthcare providers. In contrast, the review pinpointed provider-side facilitators including positive staff attitudes, service availability, and the proximity of facilities to residential homes, while user-side facilitators such as cultural assimilation and feeling valued by healthcare providers were noted. Conclusions This review identified barriers and facilitators of access to maternity care for African-born women living in Australia. Empirical evidence that would inform potential changes to policy and practice to address African-born women’s unique health needs was highlighted. Designing and implementing a culturally safe service delivery model could remove the identified access barriers and improve African-born women’s engagement in maternity care. Moreover, reinforcing factors associated with positive healthcare experiences is essential for improving maternity care access for this priority population. Systematic review registration PROSPERO CRD42023405458.

BackgroundThe COVID-19 pandemic is one of the most devastating public health emergencies of international concern to have occurred in the past century. To ensure a safe, scalable, and sustainable response, it is imperative to understand the burden of disease, epidemiological trends, and responses to activities that have already been implemented. We aimed to analyze how COVID-19 tests, cases, and deaths varied by time and region in the general population and healthcare workers (HCWs) in Ethiopia.MethodsCOVID-19 data were captured between October 01, 2021, and September 30, 2022, in 64 systematically selected health facilities throughout Ethiopia. The number of health facilities included in the study was proportionally allocated to the regional states of Ethiopia. Data were captured by standardized tools and formats. Analysis of COVID-19 testing performed, cases detected, and deaths registered by region and time was carried out.ResultsWe analyzed 215,024 individuals' data that were captured through COVID-19 surveillance in Ethiopia. Of the 215,024 total tests, 18,964 COVID-19 cases (8.8%, 95% CI: 8.7%- 9.0%) were identified and 534 (2.8%, 95% CI: 2.6%- 3.1%) were deceased. The positivity rate ranged from 1% in the Afar region to 15% in the Sidama region. Eight (1.2%, 95% CI: 0.4%- 2.0%) HCWs died out of 664 infected HCWs, of which 81.5% were from Addis Ababa. Three waves of outbreaks were detected during the analysis period, with the highest positivity rate of 35% during the Omicron period and the highest rate of ICU beds and mechanical ventilators (38%) occupied by COVID-19 patients during the Delta period.ConclusionsThe temporal and regional variations in COVID-19 cases and deaths in Ethiopia underscore the need for concerted efforts to address the disparities in the COVID-19 surveillance and response system. These lessons should be critically considered during the integration of the COVID-19 surveillance system into the routine surveillance system.

SARS-CoV-2 co-infection with the influenza virus or human respiratory syncytial virus (RSV) may complicate its progress and clinical outcomes. However, data on the co-detection of SARS-CoV-2 with other respiratory viruses are limited in Ethiopia and other parts of Africa to inform evidence-based response and decision-making. We analyzed 4,989 patients' data captured from the national severe acute respiratory illness (SARI) and influenza-like illness (ILI) sentinel surveillance sites over 18 months period from January 01, 2021, to June 30, 2022. Laboratory specimens were collected from the patients and tested for viral respiratory pathogens by real-time, reverse transcription polymerase chain reaction (RT-PCR) at the national influenza center. The median age of the patients was 14 years (IQR: 1-35 years), with a slight preponderance of them being at the age of 15 to less than 50 years. SARS-CoV-2 was detected among 459 (9.2%, 95% CI: 8.4-10.0) patients, and 64 (1.3%, 95% CI: 1.0-1.6) of SARS-CoV-2 were co-detected either with Influenza virus (54.7%) or RSV (32.8%) and 12.5% were detected with both of the viruses. A substantial proportion (54.7%) of SARS-CoV-2 co-detection with other respiratory viruses was identified among patients in the age group from 15 to less than 50 years. The multivariable analysis found that the odds of SARS-CoV-2 co-detection was higher among individuals with the age category of 20 to 39 years as compared to those less than 20 years old (AOR: 1.98, 95%CI:1.15-3.42) while the odds of SARS-CoV-2 co-detection was lower among cases from other regions of the country as compared to those from Addis Ababa (AOR:0.16 95%CI:0.07-0.34). Although the SARS-CoV-2 co-detection with other respiratory viral pathogens was minimal, the findings of this study underscore that it is critical to continuously monitor the co-infections to reduce transmission and improve patient outcomes, particularly among the youth and patients with ILI.

Tunga penetrans (Siphonaptera: Tungidae) is an ectoparasite, which causes Tungiasis in humans and animals. Tungiasis is peculiar to America, Caribbean islands, and sub–Saharan Africa. Residents in poor dwells are at a higher risk of getting Tungiasis. Social behaviors, economic status, and environmental factors are the major determinants for tungiasis. Companion animals, such as pigs, dogs, and cats are reservoirs for T.penetrans. The complete life cycle of Tunga flea takes one month to a year. Tunga flea has restricted jumping capacity and infestation is possible mostly at the lower extremities. Inflammation, self-amputation of digits, distortion and loss of nails, fissures, ulcers, gangrene and abnormal gait are some of clinical symptoms. Secondary infection also poses possible risks. Presumptive diagnosis is done by identifying lodged fleas or infected body parts and known travel history. Dermoscopy is a confirmatory method. Histological finding of the skin examination infected by Tungiasis is also possible. In sterile setup, the best treatment is surgical removal. Topical ointments like Dimethicone, Zanzarin, Ivermectin, Metrifonate, and Thiabendazole are also effective and safe. Infestations are often prevented by wearing protective clothing, spraying insecticides, sweeping floors, and personal hygiene. There is a little number of studies and the status of Tungiasis is not well known in Ethiopia, therefore further studies should be initiated and funded.

Leishmaniasis, one of the most neglected tropical diseases (NTDs), is the third most important vector-borne disease worldwide. This disease has a global impact and severity of the infection and is greatest in the Middle East. The agent of infection is a protozoan parasite of the genus, Leishmania, and is generally transmitted by blood-sucking female sandflies. In humans, there are three clinical forms of infection: (1) cutaneous (CL), (2) mucocutaneous (ML), and (3) visceral leishmaniasis (VL). This review aims to discuss the current epidemiological status of leishmaniasis in Saudi Arabia, Iraq, Syria, and Yemen with a consideration of treatment options. The elevated risk of leishmaniasis is influenced by the transmission of the disease across endemic countries into neighboring non-infected regions.

Background: The COVID-19 pandemic has impacted access to and use of maternal, newborn, and child health services. Due to lockdowns and travel restrictions implemented during the first wave of the pandemic, the provision of essential maternal health services such as family planning was critically affected. Unlike most healthcare, contraception-related services are impractical for virtual care provision as women need to attend the clinic in person. Therefore, most women across the world might have been left with an unmet need for contraception during the lockdown period. Interruptions in contraception services have led to an increased number of unintended pregnancies. With the emergence of several pocket studies, it is essential to pool the available evidence reporting the effects of COVID-19 on contraception to inform maternal health policy and practice. Objective: The aims of this review are (1) to determine the effects of the COVID-19 pandemic on access to contraceptives among sexually active women and (2) to identify the magnitude of unintended pregnancy linked to interruptions of contraceptives due to the COVID-19 pandemic. Methods: The protocol for this systematic review was registered in PROSPERO (CRD42021267077). Electronic databases such as MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, and Google Scholar will be searched for articles using appropriate key terms. The identified articles will be assessed against the eligibility criteria. Two reviewers (A.B. and T.B.) will independently screen titles and abstracts of all retrieved articles followed by a full-text review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The quality of the papers will be assessed by using the Risk of Bias Assessment tool for Non-Randomized Studies. Quantitative findings will be pooled using a random-effects model meta-analysis, while qualitative findings will be presented using a narrative synthesis. Ethics and dissemination: Ethical approval is not required. The findings will be disseminated through conference presentations and peer-reviewed publications. Discussion: This systematic review will present current data needed to design evidence-based programmes for improving access to contraception and preventing unintended pregnancy during the COVID-19 pandemic and future emergencies. Systematic review registration: PROSPERO CRD42021267077.

Abstract Next location prediction has recently gained great attention from researchers due to its importance in different application areas. Recent growth of location-based service applications has vast domain influence such as traffic-flow prediction, weather forecast, and network resource optimization. Nowadays, due to the explosive increasing of positioning and sensor devices, big trajectory data are produced related to human movement. Using this big location-based trajectory data, researchers tend to predict human next location. Research efforts are spent on the put forward overall picture of next location prediction, and number of works has been done so as to realize robust next location prediction systems. However, in-depth study of those state-of-the-art works is required to know well the applications and challenges. Therefore, the aim of this paper is an extensive review on existing different next location prediction approaches. This work offers an extensive overview of location prediction enveloping basic definitions and concepts, data sources, approaches, and applications. In next location prediction, trajectory is represented by a sequence of timestamped geographical locations. It is challenging to analyze and mine trajectory data due to the complex characteristics reflected in human mobility, which is affected by multiple contextual information. Heterogeneous data generated from different sources, users’ random movement behavior, and the time sensitivity of trajectory data are some of the challenges. In this manuscript, we have discussed various location prediction approaches, applications, and challenges, and it sheds light on important points regarding future research directions. Furthermore, application and challenges are addressed related to the user’s next location prediction. Finally, we draw the overall conclusion of the survey, which is important for the development of robust next location prediction systems.

Abstract The Kuwaiti economy is characterized by two major structural imbalances—heavy dependence on oil production and dominance of the public ownership. Kuwait has struggled over the years to implement a two-pronged development strategy —diversifying the country’s economic base away from the oil sector and promoting private sector development. This paper explores the economic impact of some policy reform options currently being considered. It employs a unique set of input–output tables, derived from supply–use tables, that distinguishes transactions made by private and public enterprises as well as providing a matrix of imports by industry. The public–private sector interdependence analysis revealed interesting results regarding sectoral differences in strengths of forward and backward linkages. For instance, the findings indicated that the strength of the publicly owned oil sectors lie in their forward linkages, supplying other sectors with their outputs, but their backward linkages is weak. On the other hand, the chemicals industry is identified as one of a few sectors with balanced and relatively strong forward and backward linkages in both public and private sector. The policy analyses conducted in this paper are highly relevant to the ongoing policy debate in Kuwait over the design of the economic reform programs. The public–private linkage analysis has revealed insights into policy synergies through which one instrument can affect more than one policy target.

This study is based on the quality of wastewater from Hawassa University surroundings, which was assessed to determine its suitability for irrigation purposes during 2019. Grab samples of influent and the treated water were taken for assessing for quality parameters. The study revealed that the treated water could be used for irrigation purpose with some moderate restrictions. Even though Electrical Conductivity (EC) and Total Dissolved Solids (TDS) permit to irrigate fruit trees and fodder crops, there is a risk of soil degradation due to high value of Sodium Adsorption Ratio (SAR). Results also indicated that carbonate, potassium and phosphate exceeded the specified limits for wastewater reuse in agriculture. Despite increased nutritive elements, continuous use of treated sewage water for irrigation will make the soil acidic. Analysis of soil parameters indicated that there is an increase in nitrogen, phosphate and potassium nutrient levels considerably to benefit crop production but increase in soil EC is a serious concern.

Effective watershed planning requires an understanding of the hydrology. In the humid tropical monsoon climates and especially in volcanic highland regions such as the Ethiopian Highlands, the understanding of watershed processes is incomplete. The objective is to better understand the hydrology of the volcanic regions in the humid highlands by linking the hillslope processes with the discharge at the outlet. The Ene-Chilala watershed was selected for this study. The infiltration rate, piezometric water levels and discharge from two nested sub watersheds and at the watershed outlet were measured during a four-year period. Infiltration rates on the hillsides exceeded the rainfall intensity most of the time. The excess rain recharged a perched hillside aquifer. Water flowed through the perched aquifer as interflow to rivers and outlet. In addition, saturation excess overland flow was generated in the valley bottoms. Perched water tables heights were predicted by summing up the recharge over the travel time from the watershed divide. Travel times ranged from a few days for piezometers close to the divide to 40 days near the outlet. River discharge was simulated by adding the interflow from the upland to overland flow from the saturated valley bottom lands. Overland flow accounted only for one-fourth of the total flow. There was good agreement between predicted and observed discharge during the rain phase therefore the hillslope hydrologically processes were successfully linked with the discharge at the outlet.

Abstract Background Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia. Methods Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson’s correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value

Abstract Background Violence against women is a major public health problem that affects the physical, sexual, mental, and social wellbeing of more than one third of all women globally. Violence against women in Ethiopia is widely acknowledged to be of great concern from human rights, economic and health perspective. The aim of this study was to assess the prevalence of intimate partner violence (IPV) against women and associated factors in Ethiopia. Method The data was obtained from 2016 Ethiopia Demographic and Health Survey which is the fourth survey conducted in Ethiopia as part of the worldwide project. The sample was selected using a stratified; two-stage cluster sampling design and the data was analyzed using logistic regression model. Result A total of 4714 ever-married women in reproductive age who reported their experience of spousal violence were considered from nine regional states and two city administratives. Over 30% of study participants were subjected to IPV. Living in rural areas, divorced, primary and secondary education, 25–39 years old, being poor are found to be predictors of IPV against women in Ethiopia. Conclusion The prevalence of IPV was found high in Ethiopia and government and any concerned bodies should design appropriate strategy and work hard to tackle the problem. There is a need of giving special attention for women living in rural area, women from poor family and 25–39 years old women to decrease the burden of IPV.

Abstract Background In sub-Saharan Africa, maternal death due to direct obstetric complications remains an important health threat for women. A high direct obstetric case fatality rate indicates a poor quality of obstetric care. Therefore, this study was aimed at assessing the magnitude and determinants of the direct obstetric case fatality rate among women admitted to hospitals with direct maternal complications. Methods In 2015, the Ethiopian Public Health Institute conducted a national survey about emergency obstetric and newborn care in which data about maternal and neonatal health indicators were collected. Maternal health data from these large national dataset were analysed to address the objective of this study. Descriptive statistics were used to present hospital specific characteristics and the magnitude of direct obstetric case fatality rate. Logistic regression analysis was performed to examine determinants of the magnitude of direct obstetric case fatality rate and the degree of association was measured using an adjusted odds ratio with 95% confidence interval at p

Abstract Background Time-to-first birth after marriage has a significant role in the future life of each individual woman and has a direct relationship with fertility. This study aimed to see the determinant of time-to-first birth interval after marriage among Ethiopian women. Methods The data was obtained from 2011 Ethiopia Demographic and Health Survey which is the third survey. The sample was selected using a stratified; two-stage cluster sampling design and the data was analysed using parametric shared frailty model. Results A total of 7925 ever married women from the nine region of the country were included in this study. Of the total women, 5966 (75.3%) of them gave firstbirth. Age, residence area, employment status, contraceptive use and education of women were associated significantly to time-to-first birth. Conclusions Women having younger age at first marriage, urban women, contraceptive users had prolonged time to first birth interval. There is a need of teaching family for contraceptive use and improving women education to increase the length of first birth interval in Ethiopia.

The aim of this study was to assess the prevalence and associated factors of gender-based violence (GBV) among second- and third-year female students of private colleges in Harar town, eastern Ethiopia . We conducted an institution-based cross-sectional study among 302 randomly selected second- and third-year female students attending private colleges in Harar town. We used descriptive statistics and logistic regression analyses. Adjusted odds ratios (AORs) with 95% confidence interval and a P value < .05 were used to interpret associations and to declare a significance of asso ciation, respectively. A total of 298 (98.7%) participants completed the questionnaire, and the overall prevalence of GBV was 57.7% (n = 172). Specifically, 36.2% of the students experienced physical violence; 46.6%, sexual violence; and 56.4%, emotional/verbal violence. The prevalence of attempted and completed rape was 36.7 and 28.8%, respectively. The following were significant predictors of GBV: age ≤ 19 years (AOR = 3.4; 95% CI, 1.4–5.3), monthly pocket money ≤ 240 Ethiopian Birr (AOR = 3.3; 95% CI, 1.7–5.9), Orthodox religion (AOR = 5.3; 95% CI, 1.9–14.4), Amhara ethnicity (AOR = 2.3; 95% CI, 1.65–4.2), living alone in a rented house (AOR = 3.2, 95% CI, 1.79–6.25), having a partner (husband or boyfriend; AOR = 4.42; 95% CI, 2.4–8.05), having a roommate with a boyfriend (AOR = 4; 95% CI, 2.8–7.6), and studying in the pharmacy department (AOR = 3.0; 95% CI, 1.1–7.6). This study found that a considerable number of female students were survivors of GBV while at college. The college authorities and other stakeholders need to combat GBV with interventions, such as GBV awareness programs, and legal protections.

Abstract Background An estimated 60% of the world’s population is infected with one form of intestinal parasites. Amoebiasis and giardiasis are among the leading intestinal protozoan infections that affected mankind. However, literature that shows the magnitude of the problem among university students in Ethiopia is at scarce. Therefore, this study was aimed at assessing the prevalence of feco-oral transmitted protozoan infections and associated factors among sport festival participant universities in Ethiopia. Methods A cross-sectional study design was conducted among 483 randomly selected university sport festival participant students. A self-administered questionnaire was used to collect the data. Stool specimens were examined using direct wet mount and formol-ether concentration techniques. The data were entered into Epi Info version 6.04 and were analyzed using SPSS version 20.0 statistical software. Multivariable logistic regression analysis was done to control the possible confounders and an odds ratio with a 95% confidence interval at p 347 Ethiopian Birr (~ 14 USD) per month (AOR = 0.20, 95% CI: 0.12, 0.74) were at lower risk of infections. However, being married (AOR = 1.42, 95% CI: 1.10, 2.23), rural resident (AOR = 1.82, 95% CI: 1.21, 3.32) and university stay for two or more years (AOR = 2.21, 95%CI: 1.48, 3.87) were more likely to be infected with protozoan infections. Conclusion The prevalence of intestinal protozoan infection among students who attend higher educational institutions was very high. Infection prevention strategies should be undertaken at respective universities with special focus to senior students and students from the rural area.

Abstract Background Intimate partner violence exposes women to a wide range of health problems that can either directly or indirectly lead to maternal death. Although in a number of studies intimate partner violence has been associated with inadequate utilization of antenatal care and skilled delivery care, in other studies no association has been found. Therefore, we aimed to comprehensively review the evidence, and quantify the strength and direction of the association between intimate partner violence and utilizing adequate antenatal and skilled delivery care services. Method We systematically searched studies from MEDLINE, Embase, Psych INFO, CINAHL, and Maternity and Infant Care. Two independent reviewers screened the articles for eligibility. Quality and risk of bias in the articles were evaluated by using the Newcastle-Ottawa scale for observational studies. Pooled odds ratios and 95% confidence intervals were computed to estimate the association of intimate partner violence and antenatal care, and skilled delivery care. Random-effects models were used to allow for the significant heterogeneity that might possibly be found between studies. The degree of heterogeneity was expressed by using the I2 statistic. Results The meta-analyses have shown that women who experienced intimate partner violence had 25% decreased odds (AOR = 0.75, 95%CI = 0.61, 0.92) of using adequate antenatal care than those who did not experience IPV. Similarly, women who experienced IPV had 20% decreased odds (AOR = 0.8, 95%CI = 0.69, 0.92) of using skilled delivery care compared to those who did not experience IPV. Conclusion The meta-analyses indicated that experiencing intimate partner violence is associated with a lower likelihood of receiving adequate antenatal care and skilled delivery care. Both community-based and facility-based interventions that target the reduction of partner violence, and strictly implementing proven health facility-based counselling interventions, could aid in improving utilization of maternal health care services.

Abstract Background According to the 2015 World Health Organization report, globally, an estimated 10.7 million mothers died from 1990 to 2015 due to obstetric complications. This report showed that almost all global maternal deaths (99%) occurred in developing countries and two thirds of these deaths took place in sub-Saharan Africa where the majority of women lack knowledge about obstetric danger signs. In Ethiopia, in several research reports, it has been indicated that women have poor knowledge about obstetric danger signs. Although several studies have been conducted to assess women’s knowledge of obstetric danger signs, to date, no systematic review has been conducted in Ethiopia. Therefore, this review is aimed at synthesising the existing literature about women’s knowledge of obstetric danger signs. Methods We systematically searched for articles from MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Web of Science, Scopus, Google Scholar and Maternity and Infant Care databases. A combination of search terms including ‘knowledge’ or ‘awareness’ or ‘information’ and ‘pregnancy danger signs’ or ‘obstetric danger signs’ or ‘obstetric warning signs’ and ‘Ethiopia’ was used to locate appropriate articles. Two reviewers conducted article screening and data abstraction independently. Observational studies published in English and conducted in Ethiopia to date were assessed for quality using the adapted Newcastle Ottawa Scale for cross-sectional studies. The PRISMA checklist was used to present the findings of this systematic review. Results From the 215 articles initially screened by abstracts and titles, 12 studies fulfilled the inclusion criteria. All the studies reported women’s knowledge of obstetric danger signs during pregnancy, ten articles reported on the level of knowledge during delivery and eight studies reported on the level of knowledge of danger signs during the postpartum period. The pooled random effect meta-analysis level of women’s knowledge about obstetric danger signs during pregnancy, delivery and postpartum was 48%, 43% and 32%, respectively. Maternal age, education, income, health service use, distance from facility and women’s autonomy were reported in several studies as determinants of women’s knowledge of obstetric danger signs. Conclusions Women’s knowledge about obstetric danger signs in Ethiopia was very poor, which could hamper access to obstetric care when women encounter obstetric complications. Counselling services during antenatal care and community-based health information dissemination about obstetric danger signs should be strengthened. Systematic review registration PROSPERO CRD42017077000

Abstract Background Nearly 15% of pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labour and complications of abortion. Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and two thirds of these deaths occurred in sub-Saharan Africa. Though the majority of maternal mortalities can be prevented, different factors can hinder women’s access to emergency obstetric services. Therefore, this review is aimed at synthesizing current evidence on barriers to access and utilization of emergency obstetric care in sub-Saharan Africa. Methods Articles were searched from MEDLINE, CINAHL, EMBASE, and Maternity and Infant Care databases using predefined search terms and strategies. Articles published in English, between 2010 and 2017, were included. Two reviewers (AG and AM) independently screened the articles, and data extraction was conducted using the Joanna Briggs Institute data extraction format. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The identified barriers were qualitatively synthesized and reported using the Three Delays analytical framework. The PRISMA checklist was employed to present the findings. Result The search of the selected databases returned 3534 articles. After duplicates were removed and further screening undertaken, 37 studies fulfilled the inclusion criteria. The identified key barriers related to the first delay included younger age, illiteracy, lower income, unemployment, poor health service utilization, a lower level of assertiveness among women, poor knowledge about obstetric danger signs, and cultural beliefs. Poorly designed roads, lack of vehicles, transportation costs, and distance from facilities led to the second delay. Barriers related to the third delay included lack of emergency obstetric care services and supplies, shortage of trained staff, poor management of emergency obstetric care provision, cost of services, long waiting times, poor referral practices, and poor coordination among staff. Conclusions A number of factors were found to hamper access to and utilization of emergency obstetric care among women in sub-Saharan Africa. These barriers are inter-dependent and occurred at multiple levels either at home, on the way to health facilities, or at the facilities. Therefore, country-specific holistic strategies including improvements to healthcare systems and the socio-economic status of women need to be strengthened. Further research should focus on the assessment of the third delay, as little is known about facility-readiness. Systematic review registration PROSPERO CRD42017074102

Background: Ethiopia is one of the sub-Saharan African countries where the young population is densely found. Many studies reveal that the magnitude of risky sexual behavior is high in the youth. The consequences of risky sexual behavior developed during youth life may affect the sexual behavior in adult life, such as increasing the risk of acquiring and transmitting sexually transmitted infections, and predisposing to unwanted pregnancies. Our objective was to assess the risky sexual behaviors among daily laborers in Arjo-Didessa Sugar Factory, Jimma Arjo district, East Wollega zone, Southwest Ethiopia. Methods: An institution-based cross-sectional study was conducted among 422 randomly selected daily laborers in the Arjo-Didessa sugar factory. For the quantitative and qualitative study, a simple random and purposive sampling technique, respectively, was employed to select the study participants. After data collection, data were checked manually for completeness, and then cleaned and entered into EPI info version 7. Statistical analyses like descriptive, bivariate, and multivariate logistic regression were performed using SPSS version 24 to determine the association between predictors and outcome variables with the help of the calculated frequencies and odds ratio with 95% confidence interval, while a p-value of less than 0.05 was taken as statistically significant. Results: The mean age of study participants was 22.15 and standard deviation of ±2.9 years. Among the study participants who responded to having sex in the past 12 months, 171 (57%) with 95% confidence interval (0.51, 0.63) had ever experienced risky sexual practices. The findings of this study indicated that age from 20 to 24 years (adjusted odds ratio = 3.9, 95% confidence interval: 1.19–12.90), marital status (single) (adjusted odds ratio = 5.5, 95% confidence interval: 1.98–15.70), khat chewing (adjusted odds ratio = 7.12, 95% confidence interval: 2.2–23.4), influence of alcohol for sex (adjusted odds ratio = 3.7, 95% confidence interval: 1.1–12.23), watching pornographic films (adjusted odds ratio = 4.2, 95% confidence interval: 1.5–12.2), and having income less than US$17 (adjusted odds ratio = 0.03, 95% confidence interval: 0.01–0.77) and US$17–US$52 (adjusted odds ratio = 0.23, 95% confidence interval: 0.06–0.85) were significantly associated with risky sexual behavior. Conclusion: This study indicated that there are high-risk sexual practices among the study population. Age, marital status, income level, khat chewing, the influence of alcohol consumption to have sex, and pornographic viewing were found to be predisposing factors of the risky sexual behaviors among daily laborers at the Arjo-Didessa sugar factory. Enhancing sexual education and consulting the targeted groups for the behavioral change is highly advisable, which can reduce the consequences of risky sexual practices that prevailed in the study area.

Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation.

Abstract Background Nearly 15% of all pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labor, and complications of abortion. Between 1990 and 2015, an estimated 10.7 million women died due to obstetric complications. Almost all of these deaths (99%) happened in developing countries, and 66% of maternal deaths were attributed to sub-Saharan Africa. The majority of cases of maternal mortalities can be prevented through provision of evidence-based potentially life-saving signal functions of emergency obstetric care. However, different factors can hinder women’s ability to access and use emergency obstetric services in sub-Saharan Africa. Therefore, the aim of this review is to synthesize current evidence on barriers to accessing and utilizing emergency obstetric care in sub-Saharan African. Decision-makers and policy formulators will use evidence generated from this review in improving maternal healthcare particularly the emergency obstetric care. Methods Electronic databases including MEDLINE, CINAHL, Embase, and Maternity and Infant Care will be searched for studies using predefined search terms. Articles published in English language between 2010 and 2017 with quantitative and qualitative design will be included. The identified papers will be assessed for meeting eligibility criteria. First, the articles will be screened by examining their titles and abstracts. Then, two reviewers will review the full text of the selected articles independently. Two reviewers using a standard data extraction format will undertake data extraction from the retained studies. The quality of the included papers will be assessed using the mixed methods appraisal tool. Results from the eligible studies will be qualitatively synthesized using the narrative synthesis approach and reported using the three delays model. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be employed to present the findings. Discussion This systematic review will present a detailed synthesis of the evidence for barriers to access and utilization of emergency obstetric care in sub-Saharan Africa over the last 7 years. This systematic review is expected to provide clear information that can help in designing maternal health policy and interventions particularly in emergency obstetric care in sub-Saharan Africa where maternal mortality remains high. Systematic review registration PROSPERO CRD42017074102.

Abstract Background Undernutrition among children continues to be a major public health problem in developing countries. In Ethiopian, 44% of under-five children were stunted while 29% and 10% were underweight and wasted respectively. However, predictors of undernutrition among children were not clearly known in the study area. Therefore, this study was aimed at determining prevalence and predictors of undernutrition among children aged 6–59 months in Hawassa town. Method A community based cross-sectional study was conducted among 811 randomly selected children paired with their mothers/caregivers. Mothers/caregivers were interviewed to obtain social-demographic data and feeding practice. Anthropometric measurement was conducted to obtain anthropometric data. Data were entered into EPI info 6.04 and exported to SPSS 16 for analysis. Bivariate logistic regression analysis with Crude Odds Ratio at 95%CI was used to assess presence of association among variables. Multivariate logistic regression analysis with Adjusted Odds Ratio at 95%CI was conducted to determine predictors of undernutrition and association was declared significant at p ≤ 0.05. Result The result of our study indicated that 39.3%, 15.8% and 6.3% of children were stunted, underweighted and wasted respectively. Multivariate logistic regression analysis identified male sex, mother older than 35 years, not fed on colostrum, cessation of breastfeeding before two years of age, frequency of complementary feeding per day and diarrheal morbidity in the last 12 months were statistically associated with stunting. Maternal education, family sizes and diarrheal morbidity in the past 12 months were significantly associated with underweight. Similarly, frequency of complementary feeding per day, age at cessation of breastfeeding, preceding birth interval and not fed on colostrum were associated to wasting. Conclusion The prevalence of undernutrition; stunting, underweight and wasting, among under-five children is very common in the study area. Inappropriate feeding practice and diarrheal morbidity were found to be the main risk factors for undernutrition. Appropriate factor specific interventions including counseling on optimal child feeding practice and diarrhea prevention should be strengthened in the study area.

Abstract Background More than a quarter of children living in Sub-Saharan Africa are underweight. Nutritional deficiency in children increases the risk of infection and affects their mental development. However, there was scarcity of research findings that clearly indicate determinants of academic performance. Therefore, this study was aimed at determining predictors of academic performance with due focus on undernutrition among students attending primary schools. Methods School based cross sectional study was conducted in February, 2016 among 630 randomly selected students attending primary schools in Hawa Galan woreda. Data were collected through parents/guardians interview, anthropometric measurement of children and school record review. Data were entered into Epidata version 3.1 and analyzed with SPSS Version 20. Anthropometric data were analyzed by WHO Anthro plus software. Pearson’s correlation analysis was performed to determine correlation between academic performance and undernutrition. Logistic regression analysis was also performed to assess predictors of academic performance and p