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Introduction Globally, diarrheal disease continues to be the second leading cause of death among under-five children, especially in developing countries. This study aimed to determine the prevalence of diarrhea and associated risk factors among under-five attending Robe Didea General Hospital (RDGH) in Arsi Robe Town, Oromia Regional State, Ethiopia, from October 1 to December 30 2020.Methods A hospital-based cross-sectional study was conducted among under-five children who attended the pediatrics department of RDGH. Systematic random sampling was employed to select the study subjects. An interviewer-administered structured questionnaire was used for data collection and the analysis used SPSS version 21. Bivariate and multivariable logistic regression analyses were employed to determine the association between risky factors and diarrheal prevalence, and a p value

Entrepreneurial orientation (EO) and environmental sustainability (ES) has recently become the subject of extensive research. The objective of this paper is to comprehensively analyze of EO and ES by conducting a bibliometric network and systematic review analysis of over ten years of publications. A total of 390 articles were identified using the Scopus and Mendeley search engines. One hundred-eighteen articles published in 53 journals between 2012 and 2021 were identified for analysis. Association analysis was conducted by author, co-author, and keyword, as well as keyword analysis by title and abstract fields, abstract field, and title field words with the highest frequency and highest relevance score under the binary counting approach. Performance, entrepreneurial orientation, relationship, entrepreneurship, entrepreneur, and business keywords were the most dominant occurrences in the abstracts. Key topics included models for entrepreneurial orientation; environmental sustainability was potentially more comprehensive in understanding the review work. This comprehensive review holds substantial theoretical significance for advancing the agenda of ecological entrepreneurial orientation and environmental sustainability. The findings of the study will help academics and researchers to identify future research directions and subject areas.

Abstract Background Disparities in child healthcare service utilization are unacceptably high in Ethiopia. Nevertheless, little is known about underlying barriers to accessing child health services, especially among low socioeconomic subgroups and in remote areas. This study aims to identify barriers to equity in the use of child healthcare services in Ethiopia. Methods Data were obtained from 20 key- informant interviews (KII) and 6 focus group discussions (FGD) with mothers and care givers. This study was conducted in Oromia Region, Arsi Zone, Zuway Dugda District from June 1–30, 2023. The study participants for this research were selected purposively. The information was collected based on the principle of saturation after sixteen consecutives interview were conducted. Both KII and FGD were audio-recorded and complementary notes were taken to record observations about the participants’ comments and their interactions. Each interview and FGD data were transcribed word-for-word in the local Afaan Oromo and Amaharic languages and then translated to English language. Finally, the data were analyzed thematically using NVivo 14 software and narrated in the linked pattern of child health service utilization. Results This study identified six major themes which emerged as barriers to healthcare utilization equity for caregivers and their -under-five children. Barriers related to equity in low level of awareness regarding need, low socioeconomic status, geographical inaccessibility, barriers related to deficient healthcare system, community perception and cultural restrictions, and barriers of equity related to political instability and conflict. The most commonly recognized barriers of equity at the community level were political instability, conflict, and a tremendous distance to a health facility. Transportation challenges, poor functional services, closure of the health facility in working hours, and lack of proper planning to address the marginalized populations were identified barriers of equity at organizational or policy level. Conclusion This study showed that inequity in child healthcare utilization is an important challenge confronting Ethiopia. To achieve equity, policy makers and planners need to change health policy and structure to be pro-poor. It is also necessary to improve the healthcare system to increase service utilization and access for impoverished women, individuals with lower levels of education, and residents of isolated rural areas. Furthermore, context specific information pertaining to cultural barriers and political ecology are required.

This study uses bibliometric techniques and social network analysis to evaluate 318 publications on air quality management in cities worldwide. The relevant data were retrieved from the Scopus database and analyzed using the VOSviewer 1.6.7 tools. The analysis included the number of publications, citation analyses, research study area analyses, and the most common keywords from 1975 to November 6, 2022. In addition, based on the results of the cluster analysis, we developed co-occurrence networks that enable a more specific keyword classification. The visualization showed the existing relationships between key terms, research study areas, and publications dealing with air quality management in cities. China, the United States, and the United Kingdom led in terms of the number of scientific publications and overall strength of connections during the study period. The most productive journal was Science of the Total Environment, followed by Atmospheric Environment, and the International Journal of Environmental Research and Public Health. Several limitations of the study are described and recommendations are made for future studies to increase the scope of studies and facilitate urban air quality management.

ABSTRACTIntroduction Tuberculosis remains a major global health problem and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of mortality worldwide. This study investigated the treatment outcome of tuberculosis and predictors of unsuccessful treatment outcome of tuberculosis (TB) patients enrolled in Arsi-Robe Hospital, central Ethiopia between January 2013 and December 2017.Methods An institution-based retrospective study was conducted on patients who had all forms of TB such as smear positive tuberculosis (PTB+), smear negative tuberculosis (PTB-), and extrapulmonary tuberculosis (EPTB) in the DOTS clinic. A multivariable logistic regression model was employed to identify predictors of unsuccessful treatment outcome and a P

Abstract Background Violence against women is a global public health problem that has numerous adverse effects. However, published literature regarding violence against housemaids during the COVID-19 pandemic in Ethiopia is lacking. The current study aims to explore the experiences of violence and associated factors among housemaids in Ethiopia. The findings may be useful to the design appropriate policies, programs and strategies to reduce the problem. Methods A community-based cross-sectional study was conducted from January to March, 2021 in Kombolcha Town, Ethiopia. A total of 215 housemaids aged 14 years and older were included in the study using a simple random sampling technique. A multivariable logistic regression model with 95% CI (confidence interval) was applied to identify significant factors of physical and sexual violence. Variables with a P-value

Introduction Despite Ethiopia’s policy intention to provide recommended vaccination services to underprivileged populations, inequity in polio immunisation persists.Objective This study examined inequity and trends in polio immunisation and determinant factors among children aged 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 analysed with the updated version of the WHO’s Health Equity Assessment Toolkit 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 analysed and disaggregated by the five equality stratifiers: economic status, education, place of residence, sex of the child and regions. Multilevel logistic regression analysis was used to identify determinant factors.Results Polio immunisation coverage was increased from 34.5% (2000) to 60.0% (2019). The wealth index-related inequity, in coverage of polio immunisation between quintiles 5 and 1, was 20 percentage points for most surveys. The population attributable risk and population attributable fraction measure in 2011 indicate that the national polio immunisation 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. The absolute difference between Addis Ababa and Afar Region was 74 percentage points in 2000 and 60 percentage points in 2019. In multilevel analysis result, individual-level factors like wealth index, maternal education antenatal care and place of delivery showed statistical significance.Conclusion Although polio immunisation coverage gradually increased over time, in the 20-year survey periods, still 40% of children remained unvaccinated. Inequities in coverage by wealth, educational status, urban–rural residence and administrative regions persisted. Increasing service coverage and improving equitable access to immunisations services may narrow the existing inequity gaps.

Background: Diarrheal illnesses are mainly linked with poverty, and hygiene promotion programs can significantly reduce childhood diarrhea when interventions are tested in stable communities. However, there is no sufficient evidence in emergency context. Methods: A cluster-randomized controlled trial was conducted in Teirkidi and Pugnido refugee camps. Intention to treat was applied in analyses of the results of this trial. Logistic, poison regression and generalized estimating equation (GEE) models were used to evaluate changes in cluster-level hygiene behaviors and period prevalence and incidence of diarrhea with its confidence intervals (95% CI) and p < 0.05 significant cutoff point. Results: The reported diarrhea episodes were 1,307 (15.6 episodes per 100 person-weeks observation) among the intervention households and 1,619 (18.9 episodes per 100 person-weeks observation) in the control households. Under-five children living in households that received hygiene promotion had a 15% [p < 0.001; adjusted IRR: 0.85, 95% CI: 0.79 0.92] and a lower incidence of diarrhea compared with children living in control households. Conclusion: The study confirms that hygiene promotion intervention significantly reduces the incidence rate of childhood diarrhea in refugee camps. Hence, gains in the reduction of childhood diarrhea can be achieved in refugee camps through an enhanced hygiene promotion program. HIGHLIGHTS My research could evaluate the burden of childhood diarrheal diseases and try to address the problem in the refugee context.; Reducing childhood diarrhea burden.;

Background: Intestinal parasitic infections (IPIs) are neglected tropical diseases. Sanitation and hygiene are vital components for achieving sustainable control of intestinal parasitic infections. Children are the most vulnerable to intestinal parasitic infections because of their immature immune systems and frequent exposure to unsanitary environments. The aim of this study was to assess the magnitude of IPIs and associated risk factors, including sanitation and hygiene practices, among under-14-year-old children in rural Dire Dawa, eastern Ethiopia. Methods: This community-based cross-sectional ’study included 778 subjects aged 1 to 14 years. Data were collected using questionnaires and stool examinations. The direct wet-mount method and formol-ether concentration techniques were performed to identify IPIs. Data Analysis: A descriptive statistic was used to show the prevalence of IPIs. Bi-variable and multivariable analysis using the logistic regression model was carried out. Results: The outputs are presented using an adjusted odds ratio (aOR) with 95% confidence intervals (CIs). The prevalence of 5 intestinal parasites was 33.7% (95% CI = 30.4%-37%). Giardia intestinalis (15.2%) and Hymenolepis nana (11.6%) had the highest prevalence. The odds of IPIs among children of illiterate mothers were 13.1 times higher when compared with children of mothers with secondary education (aOR = 13.1, P = .02), and the odds of IPIs among children from households that have unclean latrines were 1.8 times higher when compared with children from households that have clean latrines. (aOR = 1.8, P = .03). Children from households that discard solid waste in open fields had 1.7 times higher odds of having a positive result than children from households that burn their waste (aOR = 1.7, P = .03). However, children without a swimming habit (aOR = 0.4, P = .000) and asymptomatic children (aOR = 0.3, P = .000) were protective against IPIs. Conclusions: IPIs continue to be a public health problem in rural parts of Dire Dawa. The prevalence of Giardia intestinalis and H. nana could be of public health importance in this setting. Solid waste management, latrine cleanliness, mothers’ level of education, and child swimming habits in unclean accumulated water were significantly associated with IPIs. Therefore, efforts should be made to ensure intervention, considering such risks.

Aims:This study investigated the treatment success rate and the associated factors in patients with different forms of tuberculosis (TB) at Bale Robe General Hospital (BRGH), southeastern Ethiopia from 2012 to 2016.Methods:An institution-based retrospective study was conducted. The study population was patients with TB registered at BRGH. The inclusion criteria were TB diagnosis with Ziehl-Neelsen staining for acid-fast bacillus and/or radiography and having treatment initiated from 2012 through 2016. Subjects with incomplete information were excluded.Results:Among 807 patients with TB, 665 (82.4%) had successful treatment outcome (cure: 25.5%, treatment completion: 56.9%) and 142 (17.6%) patients had unsuccessful treatment outcome. In multivariate logistic regression analysis, age 65 years or older, being unemployed, having treatment after a previous failure, and receiving treatment during 2014 were associated with a reduced probability of treatment success. TB patients who were HIV-negative and treated during 2015 had higher treatment success. In multinomial logistic regression analysis, patients younger than 65 years of age showed a lower risk of death, whereas HIV-positive patients and patients treated during 2012 were more likely to experience death. New patients with TB were less likely to have treatment failure, but patients with TB who had treatment after failure were more likely to be transferred.Conclusions:This study showed that TB out treatment success rate was satisfactory but below the minimum target set by the World Health Organization (85%). Age 65 and over, being unemployed, having treatment after failure and HIV co-infection were associated with unsatisfactory treatment outcomes.

Abstract 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

Abstract Background Major efforts are being made to control the spread and impacts of the coronavirus pandemic using vaccines. Ethiopia began on March 13, 2021, to vaccinate healthcare workers (HCWs) for COVID-19 with the AstraZeneca vaccine. However, willingness to be vaccinated depends to a large extent on factors beyond the availability of vaccines. This study aimed to determine the rate of intention to refuse COVID-19 vaccination and associated factors among HCWs in northeastern Ethiopia. northeastern, Ethiopia. Method An institution-based cross-sectional study was employed among 404 HCWs in Dessie City, northeastern Ethiopia in May, 2021. Data were collected, checked, coded, entered into EpiData Version 4.6 and exported to Statistical Package of Social Sciences (SPSS) Version 25.0 for cleaning and analysis. The dependent variable was refuse to receive COVID-19 vaccination and the independent variables included socio-demographic factors, knowledge, attitudes and perceptions. A Binary logistic regression model was used to determine the association between vaccine refusal and the independent variables. From bivariate analysis, variables with p-values < 0.25 were retained for multivariable analysis. From multivariable analysis, variables with adjusted odds ratio (AOR), p-values

BackgroundAs the COVID-19 pandemic continues to ravage the world, the most pretentious sector besides the economy is the education system. Ethiopia is not equipped with the infrastructure and facilities to provide online classes for students at all levels. Hence, all institutions were re-opened with mandatory infection prevention and control (IPC) protocols such as the use of face masks, physical distancing, shifts in classes, and routine hand washing practices with soap and water to restrict the spread of the virus. Nevertheless, there has been no monitoring and follow- up and there is no data on IPC compliance among school children in the country. The purpose of this study was to examine the COVID-19 preventive practices and their associated factors among high and preparatory school students in Dessie City, Ethiopia.MethodsA cross-sectional study was carried out by using a pre-tested face-to-face applied structured questionnaire and direct observations from March 8 to March 20, 2021, in five high and preparatory schools in Dessie City. The sample size was proportionally allocated in each school based on the students' total number registered in the first academic semester, then stratified by grade level, and proportionally allocated to each grade and section. Finally, a simple random sampling method was used to select study participants. Variables with p-values < 0.25 in the bivariate logistic regression analysis were entered into the multivariate logistic regression model.ResultsThis study involved 422 students with a response rate of 98.8%. The level of good preventive practices was 43.7%. After adjusting for covariates, female, positive attitudes, received IPC training and clear accessible sharing of information and feedback with parents, students and teachers were identified as predictors of good precaution practices.ConclusionThe prevalence of good prevention practices for COVID-19 among students was relatively very low. Therefore, the Department of Health and Education of Dessie City and each school should implement environmental health programs and promote prevention practices in high schools and preparatory schools.

Abstract 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,

Abstract Background Diarrheal diseases remain a leading cause of preventable death among children under-five in low- and middle-income countries (LMICs). In Ethiopia, diarrhea is the major contributor to deaths for children under the age of 5 years. In order to develop prevention strategies for the alleviation of childhood diarrhea, it is necessary to identify the important predisposing factors. These predisposing factors have been observed to vary by location across Eastern Ethiopia. Moreover, the evidence on prevalence and determinants of diarrhea among children under 5 years of age in Dire Dawa and its suburbs is very limited and those available have been erratic. The objective of this study was to determine the prevalence and predisposing factors of diarrhea among children under the age of 5 years in rural Dire Dawa, East Ethiopia. Methods A community-based cross-sectional study was conducted in rural Dire Dawa City Administration in May 2018. Multistage sampling technique was employed to recruit 1180 under-five children from the rural population of Dire Dawa City Administration. Data on socio-demographic, environmental, and child hygiene-related factors were collected by trained data collectors using a structured questionnaire. Logistic regression was used to identify independent risk factors for childhood diarrhea. Results The 2-week prevalence of diarrhea among the under-five children was 23% (95% CI 20.8–25.7%). Maternal diarrhea (AOR = 2.22, 95% CI 1.10–4.47), handwashing after contact with child feces (AOR = 6.27, 95% CI 2.01–19.55), use of a dipper to draw water from containers (AOR = 2.88, 95% CI 1.41–5.89), and presence of a refuse disposal facility (AOR = 2.47, 95% CI 1.09–5.60) were the significant predisposing factors of diarrhea. Conclusion Our study identified a high burden of childhood diarrheal disease in rural Dire Dawa City Administration in Eastern Ethiopia. The identified risk factors were maternal diarrhea, handwashing after contact with child feces, use of a dipper to draw water from containers, and presence of refuse disposal facility. To minimize the risk of diarrhea, health education programs focusing on good hygiene practice and sanitation as well as early treatment are recommended.

Abstract 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 equation (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

The objective of this study is to investigate the adsorption performance of activated carbon derived from the leaves of Cordia africana for the removal of Cr (III) from an aqueous solution. The plant sample was collected, washed, dried, grounded, and sieved at 125 μm mesh size. Adsorbent activation was done using H3PO4 at concentrations of 25–85% and pyrolysis temperature of 400–500°C. The activated carbon was characterized by proximate, SEM, BET, and FTIR analyses. A batch adsorption study was conducted to determine the effect of contact time, adsorbent dose, initial chromium concentration, and mixing speed on Cr (III) removal. The regeneration of the activated carbon was investigated by using 1 M of HNO3 as a desorbing solution for seven cycles. At optimum acid concentration and pyrolysis temperature, a surface area of 700 m2/g was recorded. The moisture content, volatile matter, ash composition, fixed carbon, and bulk density of the activated carbon were found to be 5.3%, 24.2%, 6.2%, 64.3%, and 0.75 g/mL, respectively. The SEM and FTIR analyses indicated that the surface morphology was full of cracks and different peaks were associated with plenty of functional groups, respectively. The maximum Cr (III) removal was attained at a contact time of 180 min (89%), adsorbent dose of 1.5 g (54%), initial concentration of 0.6 g/L (47%), and mixing speed of 300 rpm (64%). The equilibrium data were better described by Freundlich isotherm at R2 value of 0.88, which implies that the adsorption process is conducted on a heterogeneous surface. The pseudo-first-order kinetics model with R2 value of 0.99 best fits with the equilibrium data, which implies that physisorption controls the adsorption kinetics. Generally, it can be concluded that this locally prepared adsorbent is promising for the removal of chromium from industrial wastewater, but further factorial approach assessment has to be checked.

Abstract 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.

Abstract 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

Abstract 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.

Abstract 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.

BackgroundPoor 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.MethodsA 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.ResultsOf 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]).ConclusionWe 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.

BackgroundIntestinal parasitosis is a major public health problem that affects the health of primary school children in low- and middle-income countries where water, sanitation, and hygiene (WASH) conditions are deficient. Since there is a paucity of information on the prevalence and associated factors of this problem among primary school children in Dessie City in Ethiopia, this study was designed to address these gaps.MethodsA school-based cross-sectional study was conducted among 407 stratified-sampled primary school children in five primary schools at Dessie City from April to June 2018. Data were collected using a pretested structured questionnaire, an observation checklist and laboratory analysis of stool samples. Stool specimen from each study participant was collected using clean, properly labeled and leak-proof stool cup. A portion of stool from each study participant collected sample was processed using saline wet mount technique and examined by microscope. The remaining specimens were preserved with 10% formalin and transported to Dessie Comprehensive Specialized Hospital laboratory to be processed by using formol-ether concentration technique. Then, slide smears were prepared from each processed stool specimen and finally, it was microscopically examined with 10x as well as 40x objectives for the presence or absence of intestinal parasites. Factors significantly associated with intestinal parasitosis were determined using binary logistic regression model at 95% CI (confidence interval). Thus, bivariate (COR [crude odds ratio]) and multivariable (AOR [adjusted odds ratio]) logistic regression analyses were carried out. From the multivariable analysis, variables having a p-value of less than 0.05 were declared as factors significantly associated with intestinal parasitosis among primary school children.Main findingsThe overall prevalence of intestinal parasitosis was found to be 16.0% (95% CI: 12.5-19.4%), of these, 50.8% were positive for protozoa, 32.2% for helminth infections and 16.9% for double co-infections. Entamoeba histolytica was the most prevalent parasite (29.2%), followed by Giardia lamblia (21.5%), Ascaris lumbricoides (18.5%), Hymenolepis nana (9.2%) and Enterobius vermicularis (4.6%). Prevalence rates were similar among government (16.3%) and private (15.7%) school children. Water consumption was less than 5 liters per capita per day in 4 of the 5 schools. Thirty-eight (9.3%) of primary school students reported that they practiced open defecation. About two-thirds (285, 70.0%) said they always washed their hands after defecation. Mother's education (illiterate) (AOR = 3.3; 95% CI: 1.20-9.37), father's education (illiterate) (AOR = 3.9; 95% CI: 1.40-10.82), fathers who could read and write (AOR = 3.3; 95% CI: 1.25-7.86), handwashing before meal (sometimes) (AOR = 2.2; 95% CI: 1.11-4.17) and poor knowledge of WASH (AOR = 9.3; 95% CI: 2.17-16.70) were statistically associated with presence of intestinal parasitic infections.ConclusionWe concluded that the prevalence of intestinal parasitosis in the study area among Grades 4-8 primary school children had public health significance. Factors significantly associated with intestinal parasitosis among primary school children's were illiterate mothers and fathers, irregular handwashing of children before meals, and poor knowledge of WASH. Health education to improve students' WASH knowledge and mass deworming for parasites are recommended as preventive measures; and improvements to the quality of WASH facilities in primary schools are strongly recommended to support these measures.

BackgroundNeedle 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.MethodsAn 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 findingsThe 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).ConclusionThis 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.

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.

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.

Abstract Background Maternal knowledge, attitudes, and practices related to hygiene, breastfeeding, sanitary food preparation, and appropriate weaning practices are potentially important determinants in the occurrence of diarrhea in children. However, few studies have been carried out about the knowledge and attitudes about childhood diarrhea among parents in refugee camps and host communities. Objective This study aims at assessing the caregivers’ knowledge and attitudes regarding acute diarrhea in under-five children among refugee and host communities in Gambella Region, Ethiopia. Methodology This cross-sectional study, employing multistage sampling, was carried out from September to December 2016. Data was collected by a questionnaire-based interview, and 1667 caregivers were included in this study. A composite knowledge score was calculated, and a five-point Likert type of attitude scale was developed to assess the attitudes of the caregivers towards childhood diarrhea. Appropriate descriptive statistics and logistic regression models were used. Odds ratios (ORs) are presented with their 95% confidence intervals (CIs), and all analyses were performed at the 5% significance level (p

Abstract Background This study aims to assess suitability of hydroponic technology for treatment of brewery wastewater in a hydroponic bioreactor using Typha latifolia. Triplicated hydroponic bioreactor treatment units were designed, constructed and operated at a hydraulic retention time of 5 days with different surface loadings and mean hydraulic loading rate 0.023 m3 m−2d− 1. Young T. latifolia shoots were collected in the vicinity of study site. Wastewater characteristics, plant growth and nutrient accumulation during experiment were analyzed as per APHA standard methods and nutrient removal efficiency was evaluated based on inlet and outlet values. Results T. latifolia established and grew well in the hydroponics under fluctuations of wastewater loads and showed a good phytoremedial capacity to remove nutrients. Significant removal efficiencies (p

Abstract Background Bioremediation is the use of biological interventions for mitigation of the noxious effects caused by pollutants in the environment including wastewater. It is very useful approach for a variety of applications in the area of environmental protection. It has become an attractive alternative to the conventional cleanup technologies that employ plants and their associated microorganisms to remove, contain, or render harmless environmental contaminants. Methods Three parallel hydroponic treatment systems (each 2 m long × 0.75 m wide × 0.65 m deep) and one control unit were filled with brewery wastewater to an effective depth of 0.5 m. Two sets of floating polystyrene platform were used for each treatment unit to support vetiver tillers for conducting bioremediation study. The wastewater was fed to the hydroponic treatment units at hydraulic loading rate of 10 cm d−1 and hydraulic residence time of 5 days. Influent and effluent samples were collected once a month for 7 months, and analyzed to determine the various parameters relating to the water quality including plant growth and nutrient analyses. Results Vetiver grass grew and established with well-developed root and shoots in the hydroponics under fluctuations of brewery wastewater loads and showed phytoremedial capacity to remove pollutants. Removal efficiencies for BOD5 and COD were significant (p

Abstract Background In Ethiopia, malaria has declined in the last decade; only a small number of cases have been reported, primarily from hotspots. The contribution of house proximity to water bodies and the role of migration in malaria transmission has not yet been examined in detail in northwest Ethiopia. Individual and household-level environmental and socio-demographic drivers of malaria heterogeneity were explored contextually in meso-endemic villages around Lake Tana, northwest Ethiopia. Methods A health facility-based paired age-sex matched case–control study involving 303 matched pairs was undertaken from 10 October 2016, to 30 June 2017. Geo-referencing of case households, control households, proximate water bodies, and health centres was carried out. A pretested and structured questionnaire was used to collect data on socio-demography, household assets, housing, travel history, and malaria intervention measures. Medians (interquartile range) were computed for continuous variables. Pearson’s Chi square/Fisher’s exact test was used to detect significant differences in proportions. Principal component analysis was performed to estimate household wealth. Stratified analysis was used to confirm confounding and interaction. A multivariable conditional logistic regression model was used to detect risk factors for malaria. Results Of 303 malaria cases, 59 (19.5% [15.4–24.3]) were imported malaria cases whereas 244 (80.5% [75.7–84.6]) were locally acquired malaria cases. In bivariate analysis, marital status, educational status, and bed net ownership were significantly associated with malaria cases. In multivariable adjustment, travel to malarious lowlands in the preceding month (adjusted mOR = 7.32; 95% CI 2.40–22.34), household member’s travel to malarious lowlands (adjusted mOR = 2.75; 95% CI 1.02–7.44), and inadequate health information on malaria (adjusted mOR = 1.57; 95% CI 1.03–2.41) were predictors of malaria. Stratified analysis confirmed that elevation of households and travel to malarious lowlands were not effect modifiers. Travel to malarious lowlands had a confounding effect on malaria but elevation of households did not. Conclusions In this study, travel to farms in the lowlands and inadequate health information on malaria were risk factors for malaria in villages around Lake Tana. This evidence is critical for the design of improved strategic interventions that consider imported malaria cases and approaches for accessing health information on malaria control in northwest Ethiopia.

Abstract The purpose of this correspondence is to describe how the positive-deviance approach can be used to translate evidence into practice, based on successive studies conducted in Ethiopia. In earlier studies, it was identified that retention in antiretroviral treatment care was variable across health facilities; and, seeking compliance across facilities, a framework was developed based on the practices of those positive-deviant health facilities, where performance was noted to be markedly better. It was found that the positive deviance approach was effective in facilitating the transfer of innovative practices (using different mechanisms) from positive-deviant health facilities to negative-deviant health facilities. As a result, the variability in retention in care across health facilities narrowed over time, increasing from 83 to 96% in 2007/8 to 95-97% in 2013/14. In conclusion, the positive-deviance approach is a valuable tool to translate evidence into practice, spread good practices, and help achieving universal health coverage.

Abstract Background Cross-cultural studies indicate that every culture has its own particular explanations for health and illness and its own healing strategies. The Konso people have always practiced indigenous medicine and have multifaceted accounts or multiple dimensions of illness perceptions and health-care beliefs and practices. This paper describes how perceptions of health and illness are instrumental in health and treatment outcomes among the Konso people in southwestern Ethiopia. Results may provide an understanding of the perceptions of health and illness in relation to the local cosmology, religion, and environment. Methods The ethnographic method was employed to generate evidence, complemented by focus group discussions, in-depth interviews, and direct observation. Thematic analysis was employed to categorize and interpret the data. Results Findings indicate that the Konso people’s worldview, particularly as it relates to health, illness, and healing systems, is closely linked to their day-to-day lives. Older people believe illnesses are caused by a range of supernatural forces, including the wrath of God or local gods, oritta (spirit possession), and karayitta (ancestral spirits), and they use culturally prescribed treatment. Young and formally educated members of the community attribute causes of diseases to germitta (germs) and factorta (bacteria) and tend to seek treatment mostly in modern health facilities. Conclusion Perceptions of health and illness as well as of healing are part of Konso people’s worldview. Local communities comprehend health problems and solutions within their cultural frame of reference, which has changed over the years. The Konso people associate their health situations with socio-cultural and religious factors. The individual’s behavior and interactions with the social, natural, and supernatural powers affect the well-being of the whole group. The individual, the family, the clan leaders, and the deceased are intimately linked to one’s culturally based health beliefs and are associated by the Konso with health problems and illnesses.

Abstract Background Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia. Methods A community-based cross-sectional study design was employed in five rounds of surveys in seven kebeles in slums of Addis Ababa among 472 mothers/caregivers of 472 under-five children with acute diarrhea in reference to Andersen’s behavioral model. Data were entered into EpiData Version 3.1 and analyzed using STATA Version 14.0. Descriptive statistics were used to examine patterns of health facilities utilization and multivariable logistic regression analysis was applied to identify predictors associated with health-seeking behavior. Results Most mothers/caregivers (70.8%) sought care either at home (14.2%) or health facilities (56.6%), whereas 29.2% reported that they did not seek any care. Of those who consulted health facilities, government health facilities (76.9%) were more utilized than private (18.0%) and informal (5.1%) health facilities. Nearly all (93.9%) of the mothers/caregivers using government health facilities used health centers, and of those who took their children to private health facilities (60.9%) used clinics and 26.1% used pharmacies/drug vendors. Mothers/caregivers visiting health facilities obtained mainly oral rehydration salt (ORS) (39.8%) and home-recommended fluids (HRF) (40.3%), but few of them (11.9%) obtained ORS plus zinc supplementation. Predisposing factors of literacy of mothers/caregivers (adjusted odds ratio (AOR) = 2.4; 95% CI 1.4–4.1) and occupation (AOR = 2.6; 95% CI 1.5–4.6), the enabling factors of households monthly income of 50 United States Dollars (US$) and above (AOR = 2.9; 95% CI 1.5–5.6) and availability of nearest health facilities within 15 min walking distance (AOR = 3.3; 95% CI 1.7–6.6), and the need factors of recognizing danger signs of fever (AOR = 4.3; 95% CI 2.4–7.6) and vomiting (AOR = 3.3; 95% CI 1.8–5.9) were significantly associated with health-seeking behavior. Conclusions Increasing the proximity of health facilities in slums and health education and socioeconomic development programs targeting illiterate mothers/caregivers and poor households may promote and increase health-seeking behavior and the accessibility of health facilities for the treatment of acute diarrhea in under-five children in Addis Ababa slums.

Background Pneumonia 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. Methods A 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 findings The 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. Conclusion In 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.

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.

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.

IntroductionDespite the government's efforts to decentralize and expand health institutions to promote facility-based child delivery, home delivery and maternal mortality are still widespread problems in Ethiopia. Most mothers continue to give birth at home. This study aims at identifying the socio-cultural practices, perceived benefit or need, and accessibility factors influencing women's choice of health facilities for delivery services in Gida Ayana Woreda, western Ethiopia.MethodsWe conducted a cross-sectional survey to assess women's use of delivery care services in Gida Ayana Woreda, from November 2016 to January 2017; 459 women who were selected randomly participated in the study. We evaluated the socio-cultural, perceived benefit or need, and economic and physical accessibility factors in women's choice of delivery care and used adjusted logistic regression analysis to examine significant predictors of delivery site use decisions.ResultsOver half (56.6%) of the women self-reported using institutional delivery care; 80.9% gave birth at a health center. A socio-cultural variable, maternal education, significantly influenced women's choice of health facility for delivery care services (AOR 3.4; 95% CI 2.0-5.9). Mothers' knowledge level of obstetric complications and experience of complications during the last birth were the two perceived benefits or need factors associated with higher odds of receiving delivery care from decentralized local facilities. Utilization of health centers for maternal delivery care was significantly higher than of health posts (AOR 5.0; 95% CI 2.4-10.2). Availability of motorized transportation during labor to nearby delivery site was a significant predictor of institutional delivery.ConclusionThis study demonstrates the under-utilization of decentralized health facilities for maternal delivery care services in Gida Ayana Woreda, which was significantly influenced by socio-cultural, perceived need, and accessibility factors of women during childbirth. This suggests the need for tailored intervention to improve childbirth services use for mothers in this kind of rural settings.

INTRODUCTION: Childhood diarrhea is highly prevalent in slums in developing countries, but it remains understudied. The objectives of this study were to explore the prevalence of Giardia, rotavirus and bacterial enteropathogens among diarrheic and non-diarrheic children and investigate socio-environmental determinants of diarrhea in two Ethiopian towns. METHODS: a cross-sectional study was conducted from June to October 2016. Prevalence of childhood diarrhea was established using information gathered during interviews with mothers/guardians. Saline wet mounts of fresh stool samples were used to test for the presence of Giardia. Stool samples were cultured on MacConkey agar and suspected colonies were characterized using biochemical tests. Susceptibility testing was done by the disk diffusion method. ELISA was used to screen for rotavirus. RESULTS: a total of 225 children were included in this study. Four enteropathogens (Giardia, rotavirus, Shigella and Salmonella) were identified from 31% (35/112) diarrheic and 12% (14/113) from non-diarrheic children (p = 0.001). The prevalence of rotavirus infection was 18.0% among diarrheic children and 3.3% among non-diarrheic children unvaccinated against rotavirus (p = 0.01). The prevalence of Giardia was 21.0% among diarrheic and 8.0% among non-diarrheic children (p = 0.01). Diarrheic children had significantly higher rates of bloody stool (p =0.02), vomiting, fever and breastfeeding for children beyond 23 months of age (p =0.001). Giardia and rotavirus were identified in more diarrheic than non-diarrheic children. CONCLUSION: the high prevalence of Giardia and rotavirus in the study area indicates the need for coordinated healthcare activities in the two communities. Vaccination against rotavirus infections and educational interventions are recommended.

In developing countries, children under the age of five years who live in slums are highly vulnerable to diarrhea. However, there is a paucity of information on the relationship between sanitation facilities and hygienic conditions to acute diarrhea among under-five children in slum areas of Addis Ababa, Ethiopia. Therefore, this study examines the sanitation facilities and hygienic conditions in the slums of Addis Ababa and identifies the main factors significantly associated with acute diarrhea among children aged 0-50 months in those slums.A community-based cross-sectional household survey was carried out between September and November 2014, that then served as the baseline survey of a longitudinal study. For this survey, 697 children aged 0-50 months were recruited from two slum districts in Addis Ababa. A pre-tested structured questionnaire and an observational checklist were used for data collection. Multivariable logistic regression analysis was used to identify sanitation facilities and hygiene-related factors that were significantly associated with acute diarrhea by controlling potential confounding effects of selected socio-demographic factors. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was used to quantify the strength of association.The prevalence of acute diarrhea among children aged 0-50 months in the study area was 11.9% and 94.6% of the sanitation facilities were unimproved. Sharing of a sanitation facility by six or more households (AOR = 4.7; 95% CI: 2.4-9.4), proximity of sanitation facilities within 15 meters of homes (AOR = 6.6; 95% CI: 2.5-17.0), presence of feces (AOR = 3.9; 95% CI: 1.5-10.3) and flies (AOR = 2.5; 95% CI: 1.3-5.0) on the floor of and/or around sanitation facilities, and presence of uncollected garbage inside house compounds (AOR = 3.2; 95% CI: 1.2-8.4) were significantly associated with acute diarrhea.This study reveals the slum environment to be high risk for diarrhea due to close proximity of sanitation facilities to homes, sharing of sanitation facilities, and poor hygiene of the sanitation facilities and housing compounds. We recommend the development of a comprehensive diarrheal disease prevention program that focuses on improving the cleanliness of the sanitation facilities and housing compounds. Increasing the number of improved sanitation facilities at an appropriate distance from houses is also essential in order to reduce the number of households that share one latrine.

The problem of intermittent piped water supplies that exists in low- and middle-income countries is particularly severe in the slums of sub-Saharan Africa. However, little is known about whether there is deterioration of the microbiological quality of the intermittent piped water supply at a household level and whether it is a factor in reducing or increasing the occurrence of acute diarrhea among under-five children in slums of Addis Ababa. This study aimed to determine the association of intermittent piped water supplies and point-of-use (POU) contamination of household stored water by Escherichia coli (E. coli) with acute diarrhea among under-five children in slums of Addis Ababa.A community-based matched case-control study was conducted from November to December, 2014. Cases were defined as under-five children with acute diarrhea during the two weeks before the survey. Controls were matched by age and neighborhood with cases by individual matching. Data were collected using a pre-tested structured questionnaire and E. coli analysis of water from piped water supplies and household stored water. A five-tube method of Most Probable Number (MPN)/100 ml standard procedure was used for E. coli analysis. Multivariable conditional logistic regression with 95% confidence interval (CI) was used for data analysis by controlling potential confounding effects of selected socio-demographic characteristics.During the two weeks before the survey, 87.9% of case households and 51.0% of control households had an intermittent piped water supply for an average of 4.3 days and 3.9 days, respectively. POU contamination of household stored water by E. coli was found in 83.3% of the case households, and 52.1% of the control households. In a fully adjusted model, a periodically intermittent piped water supply (adjusted matched odds ratio (adjusted mOR) = 4.8; 95% CI: 1.3-17.8), POU water contamination in household stored water by E. coli (adjusted mOR = 3.3; 95% CI: 1.1-10.1), water retrieved from water storage containers using handle-less vessels (adjusted mOR = 16.3; 95% CI: 4.4-60.1), and water retrieved by interchangeably using vessels both with and without handle (adjusted mOR = 5.4; 95% CI: 1.1-29.1) were independently associated with acute diarrhea.We conclude that provision of continuously available piped water supplies and education of caregivers about proper water retrieval methods of household stored water can effectively reduce POU contamination of water at the household level and thereby reduce acute diarrhea among under-five children in slums of Addis Ababa. Promotion of household water treatment is also highly encouraged until the City's water authority is able to deliver continuously available piped water supplies.

Praziquantel (PZQ) is an effective chemotherapy for schistosomiasis mansoni and a mainstay for its control and potential elimination. However, it does not prevent against reinfection, which can occur rapidly in areas with active transmission. A guide to ranking the risk factors for Schistosoma mansoni reinfection would greatly contribute to prioritizing resources and focusing prevention and control measures to prevent rapid reinfection. The objective of the current study was to explore the relationship among the socioeconomic, demographic, and epidemiological factors that can influence reinfection by S. mansoni one year after successful treatment with PZQ in school-aged children in Northeastern Minas Gerais state Brazil. Parasitological, socioeconomic, demographic, and water contact information were surveyed in 506 S. mansoni-infected individuals, aged 6 to 15 years, resident in these endemic areas. Eligible individuals were treated with PZQ until they were determined to be negative by the absence of S. mansoni eggs in the feces on two consecutive days of Kato-Katz fecal thick smear. These individuals were surveyed again 12 months from the date of successful treatment with PZQ. A classification and regression tree modeling (CART) was then used to explore the relationship between socioeconomic, demographic, and epidemiological variables and their reinfection status. The most important risk factor identified for S. mansoni reinfection was their "heavy" infection at baseline. Additional analyses, excluding heavy infection status, showed that lower socioeconomic status and a lower level of education of the household head were also most important risk factors for S. mansoni reinfection. Our results provide an important contribution toward the control and possible elimination of schistosomiasis by identifying three major risk factors that can be used for targeted treatment and monitoring of reinfection. We suggest that control measures that target heavily infected children in the most economically disadvantaged households would be most beneficial to maintain the success of mass chemotherapy campaigns.

The objective of the present paper was to compare accessibility and utilisation of schistosomiasis diagnostic and treatment services in a small village and the surrounding rural area in northern part of the state of Minas Gerais Brazil. The study included 1,228 individuals: 935 central village residents and 293 rural residents of São Pedro do Jequitinhonha. Schistosoma mansoni infection rates were significantly higher in the central village than in the rural area during a survey in 2007 (44.3% and 23.5%, respectively) and during the 2002 schistosomiasis case-finding campaign (33.1% and 26.5%, respectively) (p < 0.001). However, during the 2002-2006 period, only 23.7% of the villagers and 27% of the rural residents obtained tests on their own from health centres, hospitals and private clinics in various nearby towns. In 2007, 63% of the villagers and 70.5% of the rural residents reported never having received treatment for schistosomiasis. This paper reveals considerable variation in the accessibility and utilisation of schistosomiasis-related health services between the central village and the rural area. A combination of low utilisation rates between 2002-2006 and persistently high S. mansoni infection rates suggest that the schistosomiasis control program must be more rapidly incorporated into the primary health services.

This paper examines recent developments in migration studies. It reviews literature related to the potential role of internal population movement in the occurrence of schistosomiasis in Brazil and modifies Prothero's typology of population movement for use in Brazil. This modified classification system may contribute to a better understanding of schistosome transmission as well as improved research and control programs. The results of this study indicate that population movement in Brazil primarily involves economically-motivated rural-urban and interregional movement. However, several movement patterns have become increasingly important in recent years as a result of changing socioeconomic and urbanisation dynamics. These patterns include urban-urban, intracity and urban-rural movement as well as the movement of environmental refugees and tourists. Little is known about the epidemiological significance of these patterns. This paper also highlights the role of social networks in the decision to migrate and to settle. Prothero's classic population movement typology categorises movement as either one-way migrations or circulations and examines them along spatial and temporal scales. However, the typology must be modified as epidemiological information about new patterns becomes available. This paper identifies areas that require further research and offers recommendations that can improve the measurement and spatial analysis of the relationship between population movement and schistosomiasis.

The rapidly increasing number of spatial studies and the complexity of schistosomiasis transmission dynamics in Brazil indicate that surveillance and control programmes can benefit from the spatial approach, not only in areas susceptible to the introduction and establishment of new transmission foci but also in areas experiencing declines in schistosomiasis transmission. Several additional areas amenable to, or requiring, spatial research are identified. This paper reviews spatial studies of schistosomiasis in Brazil with a focus on the application of spatial tools in epidemiological, disease ecological, control and several additional areas in schistosomiasis research.

The objective of this study was to analyse the effect of using two health education approaches on knowledge of transmission and prevention of schistosomiasis of school children living in a rural endemic area in the state of Minas Gerais, Brazil. The 87 children participating in the study were divided into three groups based on gender, age and presence or absence of Schistosoma mansoni infection. In the first group the social representation model and illness experience was used. In the second group, we used the cognitive model based on the transmission of information. The third group, the control group, did not receive any information related to schistosomiasis. Ten meetings were held with all three groups that received a pre-test prior to the beginning of the educational intervention and a post-test after the completion of the program. The results showed that knowledge levels in Group 1 increased significantly during the program in regard to transmission (p = 0.038) and prevention (p = 0.001) of schistosomiasis. Groups 2 and 3 did not show significant increase in knowledge between the two tests. These results indicate that health education models need to consider social representation and illness experience besides scientific knowledge in order to increase knowledge of schistosomiasis transmission and prevention.

Schistosomiasis prevalence and egg counts remained low one year after chemotherapy in most households in a hyperendemic rural area in northern Minas Gerais but several distinct spatial patterns could be observed in relation to IgE levels and to a lesser extent to exposure risk (TBM) and type of water supply. An inverse relationship between pre-treatment household prevalence and egg counts on the one hand and post-treatment IgE levels on the other were noted in two of the five communities. Low exposure risk was associated with the low pre-treatment infection rates in the central village but did not contribute to the decline of infection rates after chemotherapy in the study area, as indicated by the significant increase in water contact during the posttreatment period (p < 0.0001). Distance between households and the streams and socioeconomic factors were also unimportant in predicting the spatial distribution of infection. These results are consistent with the production and antiparasitic effect of high levels of IgE in Schistosoma mansoni infection.

This paper examines the distribution and infection of Biomphalaria glabrata with Schistosoma mansoni in all aquatic snail habitats in a rural area in the state of Minas Gerais, Brazil, in relation to physico/biotic and behavioral factors. Snail and environmental surveys were carried out semi-annually between July 2001 and November 2002 at 106 sites. Collected snails were examined in the laboratory for infection. B. glabrata densities were highest in overflow ponds, irrigation ponds, springs, canals and wells, and lowest in fishponds and water tanks. Snail densities were higher during the hot, rainy season except for streams and canals and were statistically associated with the presence of fish, pollution, and vegetation density. Tilapia fish and an unidentified Diptera larva were found to be predators of B. glabrata but ducks were not. Twenty-four of the 25 infected snails were collected in 2001(1.4% infection rate) and only one in 2002, after mass chemotherapy. The occurrence of B. glabrata in all 11 snail habitats both at and away from water contact sites studied indicates widespread risk of human infection in the study area. In spite of the strong association between B. glabrata and tilapia in fishponds we do not recommend its use in schistosomiasis control for ecological reasons and its relative inefficiency in streams and dams.

The dichloromethane extract prepared from the underground parts of Eleutherine bulbosa (Miller) Urban (Iridaceae) showed strong activity in the direct bioautography assay with the phytopathogenic fungus Cladosporium sphaerospermum. This assay was used to guide the fractionation of this extract and allowed the isolation of four compounds: the new naphthoquinone eleutherinone[8-methoxy-1-methyl-1,3-dihydro-naphtho(2,3-c)furan-4,9 -dione] and the known compounds, previously isolated from this species, eleutherin [9-methoxy-1(R),3(S)-dimethyl-3,4-dihydro-1H-benzo(g)isochromene-5,10-dione], isoeleutherin [9-methoxy-1(R),3(R)-dimethyl-3,4-dihydro-1H-benzo(g)isochromene-5,10-dione], and eleutherol [4-hydroxy-5-methoxy-3(R)-methyl-3H-naphtho(2,3-c)furan-1 -one]. All quinonoid compounds showed strong antifungal activity in the bioautography assay at 100 µg/spot, while eleutherol was inactive.