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Abstract Background Contraception is a critical service for women to control their reproductive health, allowing them to determine the number and spacing of their children prevent unintended pregnancies, reduce the risk of morbidity and mortality from associated with childbirth, and reduce the likelihood of abortions. Despite its benefits, the utilization of modern contraceptive methods remains low in certain regions of Ethiopia, Particularly in Afar and Somali, which are also experiencing high fertility rates. However, there is a substantial gap in understanding the sociocultural barriers that hinder the adoption of modern contraception in these regions. This study aims to explore these barriers to contraceptive use among women of reproductive age in Afar and Somali regions, providing qualitative insights that are essential for designing effective strategies to improve contraceptive service utilization. Methods Asequential mixed method approach was employed, including scoping review and qualitative interviews. Scoping review focused on qualitative or mixed-methods studies conducted in Ethiopia and published between 2013 and 2023 in English, Selecting 14 articles Additionally, qualitative data were collected from Afar and Somali regions through In-depth interviews with women aged 15–49 who are married or in consensual union, and key informant interviews with health extension workers and contraception providers at health center. A total of 20 in-depth interviews and 07 key informants were conducted. Thematic analysis was used to analyze the data. Result The integrated findings from the scoping review and qualitative study reveal various barriers and determinants influencing contraceptive use among women in Ethiopia. Barriers includes religious or cultural beliefs, myths and misconceptions, fear of side effects, lack of knowledge and misinformation, negative attitude towards contraceptives, partner opposition, socio-cultural factors, fear of being judged by family and friends, and lack of communication between husband and wife, husband altitude, distance from health facility, availability of service and different contraceptive choice, separate room for family planning services, and cost of contraceptive method and transportation. The scoping review corroborates these findings, emphasizing on the role of socio-demographic, economic, cultural, religious, health service, and knowledge-related factors. Higher education, urban residence, higher income, mass media exposure, spousal communication, family size, and access to quality health services were associated with increased utilization, while lack of awareness, misconceptions, myths, side effects, fear of infertility, partner opposition, social stigma, and cultural norms decreased utilization. Conclusion The study recommended promoting contraceptive use, challenging socio-cultural norms through Social Behavioural Communication and Counselling (SBCC), engaging partners and community members, and improving the quality of care.

Ethiopia is experiencing considerable impact of climate change and variability in the last five decades. Analyzing climate trends and variability is essential to develop effective adaptation strategies, particularly for countries vulnerable to climate change. This study analyzed trends and variabilities of climate (rainfall, maximum temperature (Tmax), and minimum temperature (Tmin)) at local and regional scales in Ethiopia. The local analysis was carried out considering each meteorological station, while the regional analyses were based on agro-ecological zones (AEZs). This study used observations from 47 rainfall and 37 temperature stations obtained from the Ethiopian Meteorological Institute (EMI) for the period of 1986 to 2020. The Modified Mann-Kendall (MMK) trend test and Theil Sen's slope estimator were used to analyze the trends and magnitudes of change, respectively, in rainfall as well as temperature. The coefficient of variation (CV) and standardized anomaly index (SAI) were also employed to evaluate rainfall and temperature variabilities. The local level analysis revealed that Bega (dry season), Kiremt (main rainy season), and annual rainfall showed increasing trend, albeit no significant, in most stations, but the rainfall in Belg (small rainy) season showed a non-significant decreasing trend. The regional levels analysis also indicated an increasing trend of Bega, Kiremt, and annual rainfall in most AEZs, while Belg rainfall showed a decreasing trend in the greater number of AEZs. The result of both local and regional levels of analysis discerned a spatially and temporally more homogeneous warming trend. Both Tmax and Tmin revealed an increasing trend in annual and seasonal scales at most meteorological stations. Likewise, an increase was recorded for mean Tmax and Tmin in entire/most AEZs. The observed trends and variabilities of rainfall and temperature have several implications for climate change adaptations. For example, the decrease in Belg rainfall in most AEZs would have a negative impact on areas that heavily depend on Belg season's rainfall for crop production. Some climate adaptation options include identifying short maturing crop varieties, soil moisture conservation, and supplemental irrigation of crops using harvested water during the main rainy season. Conversely, since the first three months of Bega season (October to December) are crop harvest season in most parts of Ethiopia, the increase in Bega rainfall would increase crop harvest loss, and hence, early planting date and identifying short maturing crops during the main rainy season are some climate adaptation strategies. Because of the increase in temperature, water demand for irrigation during Bega season will increase due to increased evapotranspiration. On the other hand, the increase in Kiremt rainfall can be harvested and used for supplemental irrigation during Bega as well as the small rainy season, particularly for early planting. In view of these findings, it is imperative to develop and implement effective climate-smart agricultural strategies specific to each agro-ecological zone (AEZ) to adapt to rainfall and temperature changes and variabilities.

Article Highlights The annual precipitation of the sub-basin has shown an increasing trend. A considerable upward trend in the annual average temperature was found. The observed rainfall and temperature trends are associated with the hydro-climate trends.

Ethiopia, a densely populated country with abundant natural resources, is often hit by climate extreme disasters that cause severe damage to life and property every year in one or the other corner. The frequency and intensity of extreme events have increased in the recent decades due to climate change and variability. This study aimed to analyze the changes in observed rainfall and minimum and maximum temperature extremes in the Upper Blue Nile Basin (UBNB) of Ethiopia from 1980 to 2019 periods. The Mann-Kendall (MK) trend test and Theil-Sen's slope estimator were used to estimate annual and seasonal trends. The rainfall and temperature extremes were analyzed using RClimDex, which is a graphical user interface in R software, by selecting ten rainfall and eleven temperature indices. The results showed a positive trend in annual, dry (March–May) and small rain (October–February) seasons rainfall in more than 54% of the stations and a decreasing trend in the main rain (June–September) season rainfall in 65.4% of the stations. Several extreme rainfall indices showed insignificant positive trends in the basin. Although there is a positive trend in extreme rainfall, the number of consecutive wet days (CWD) and the simple daily intensity index (SDII) show insignificant negative trends in most stations. In addition, a warming trend of the annual and seasonal maximum and minimum temperature extreme indices was noted. Overall, the increase in extreme rainfall and a warming trend in the extreme temperature indices indicate signs of climate change in the UBNB. The findings of this study suggests the need for developing climate change adaptation and mitigation strategies in the UBNB.

Climate extreme events have been observed more frequently since the 1970s throughout Ethiopia, which adversely affects the socio-economic development of the country, as its economy depends on agriculture, which, in turn, relies heavily on annual and seasonal rainfall. Climate extremes studies conducted in Ethiopia are mainly limited to a specific location or watershed, making it difficult to have insights at the national level. The present study thus aims to examine the observed climate extreme events in Ethiopia at both station and agro-ecological zone (AEZ) levels. Daily rainfall and temperature data for 47 and 37 stations, respectively (1986 up to 2020), were obtained from the National Meteorology Agency (NMA). The Modified Mann–Kendall (MMK) trend test and the Theil–Sen slope estimator were employed to estimate the trends in rainfall and temperature extremes. This study examines trends of 13 temperature and 10 rainfall extreme indices using RClimDex in R software. The results revealed that most of the extreme rainfall indices showed a positive trend in the majority of the climate stations. For example, an increase in consecutive dry days (CDD), very heavy rainfall days (R20), number of heavy rainfall days (R10) and consecutive wet days (CWD) were exhibited in most climate stations. In relation to AEZs, the greater number of extreme rainfall indices illustrated an upward trend in cool and sub-humid, cool and humid, and cool and moist AEZs, a declining trend in hot arid AEZ, and equal proportions of increasing and decreasing trends in warm semi-arid AEZs. Concerning extreme temperature indices, the result indicated an increasing trend of warm temperature extreme indices and a downward trend of cold temperature extreme indices in most of the climate stations, indicating the overall warming and dryness trends in the country. With reference to AEZs, an overall warming was exhibited in all AEZs, except in the hot arid AEZ. The observed trends in the rainfall and temperature extremes will have tremendous direct and indirect impacts on agriculture, water resources, health, and other sectors in the country. Therefore, the findings suggest the need for identifying and developing climate change adaptation strategies to minimize the ill effects of these extreme climate events on the social, economic, and developmental sectors.

Abstract Background The rapid growth and changes that occur in adolescents increase the demand for macro and micronutrients and addressing their needs particularly in females would be an important step to break the vicious cycle of intergenerational malnutrition. Thus we evaluated the status of anemia and its anthropometric, dietary and socio demographic determinants in female adolescents, west Ethiopia. Methods A school based cross-sectional study was conducted among school going adolescent girls of Wayu Tuqa district, south west Ethiopia and a 3-stage random sampling technique was used to select study participants. Data were entered into EpiData version 3.1 and analyzed using STATA version12. Haemoglobin was measured by HemoCue 301+ photometer and WHO Anthro-plus software Version 1.0.4 was used to calculate BMI for age z-score. Both bivariate and multivariate analyses were performed to check associations and control confounding. A p-value

Introduction: Helminth infection has a profound effect on the immune system. However, the precise nature of the immune changes that are elicited by helminth infection have not been sufficiently characterized. Furthermore, the reversibility of these changes after treatment has not been documented sufficiently. We studied the immune profiles of Ethiopian immigrants to Israel at baseline, that is on arrival and at one-year follow-up and compared individuals who received antihelminthic treatment during the study period with those who missed the treatment. Methods: A longitudinal follow up study involving different groups of subjects was conducted. Baseline data was recorded from the newly arrived Ethiopian immigrants for a series of peripheral blood tests, including: IgE and Eosinophil levels, T-cell populations, T-cell receptor phenotypes, and cytokine measurement. These tests were all repeated after a 1-year interval. Results were compared between the newly arrived Ethiopian immigrants (NEW-Eth-Il), long term Ethiopian immigrants (LT-Eth-Il), and non Ethiopian Israeli controls (NON-Imm-Il). Results: Of the 184 individuals, 111 were NEW-Eth-Il, who had a high prevalence of helminth infection, the immunological changes were elevated IgE levels and eosinophil counts, decreased CD4/CD8 ratio, increased proportion of HLA-DR+CD3+, HLA-DR+CD4+ and HLA-DR+CD8+ cells, decreased proportion of CD45RA+CD4+ (naive) and CD28+CD8+ cells, increased proportion of CD45RO+CD4+ (memory) cells, and increased secretion of IL-4 and IL-5 (Th2 type cytokines). In the 42 LT-Eth-Il participants, who all had negative tests for helminth infection, we did not observe these immune changes and their immune profile did not differ markedly from that of the NON-Imm-Il controls. The follow-up immune profiles of 33 NEW-Eth-Il who received succesful antihelminth treatment, showed a significant normalization in the above-mentioned variables that was not observed in the 19 NEW-Eth-Il who missed and did not receive the antihelminth treatment. Conclusions: These findings demonstrate that helminth infection is associated with profound immune changes that are normalized within a short time after helminth eradication. They also strengthen the hypothesis that effective antihelminth interventions, in areas endemic for intestinal helminths, may have an impact on AIDS and tuberculosis epidemics.

Since the 1800s, the only known vector of Borrelia recurrentis has been the body louse. In 2011, we found B. recurrentis DNA in 23% of head lice from patients with louse-borne relapsing fever in Ethiopia. Whether head lice can transmit these bacteria from one person to another remains to be determined.

Visceral leishmaniasis is a parasitic disease associated with high mortality. The most important foci of visceral leishmaniasis in Ethiopia are in the Northwest and are predominantly associated with high rates of HIV co-infection. Co-infection of visceral leishmaniasis patients with HIV results in higher mortality, treatment failure and relapse. We have previously shown that arginase, an enzyme associated with immunosuppression, was increased in patients with visceral leishmaniasis and in HIV seropositive patients; further our results showed that high arginase activity is a marker of disease severity. Here, we tested the hypothesis that increased arginase activities associated with visceral leishmaniasis and HIV infections synergize in patients co-infected with both pathogens.We recruited a cohort of patients with visceral leishmaniasis and a cohort of patients with visceral leishmaniasis and HIV infection from Gondar, Northwest Ethiopia, and recorded and compared their clinical data. Further, we measured the levels of arginase activity in the blood of these patients and identified the phenotype of arginase-expressing cells. Our results show that CD4(+) T cell counts were significantly lower and the parasite load in the spleen was significantly higher in co-infected patients. Moreover, our results demonstrate that arginase activity was significantly higher in peripheral blood mononuclear cells and plasma of co-infected patients. Finally, we identified the cells-expressing arginase in the PBMCs as low-density granulocytes.Our results suggest that increased arginase might contribute to the poor disease outcome characteristic of patients with visceral leishmaniasis and HIV co-infection.

BACKGROUND:In Africa, relapsing fever borreliae are neglected arthropod-borne pathogens causing mild to deadly septicemia and miscarriage. The closely related Borrelia crocidurae, Borrelia duttonii, Borrelia recurrentis and Borrelia hispanica are rarely diagnosed at the species level, hampering refined epidemiological and clinical knowledge of the relapsing fevers. It would be hugely beneficial to have simultaneous detection and identification of Borrelia to species level directly from clinical samples. METHODOLOGY/PRINCIPAL FINDINGS:We designed a multiplex real-time PCR protocol targeting the 16S rRNA gene detecting all four Borrelia, the glpQ gene specifically detecting B. crocidurae, the recN gene specifically detecting B. duttonii/B. recurrentis and the recC gene specifically detecting B. hispanica. Compared to combined 16S rRNA gene and flaB gene sequencing as the gold standard, multiplex real-time PCR analyses of 171 Borrelia-positive and 101 Borrelia-negative control blood specimens yielded 100% sensitivity and specificity for B. duttonii/B. recurrentis and B. hispanica and 99% sensitivity and specificity for B. crocidurae. CONCLUSIONS/SIGNIFICANCE:The multiplex real-time PCR developed in this study is a rapid technique for both molecular detection and speciation of relapsing fever borreliae from blood in Africa. It could be incorporated in point-of-care laboratory to confirm diagnosis and provide evidence of the burden of infection attributed to different species of known or potentially novel relapsing fever borreliae.

BACKGROUND: In Africa, relapsing fevers are neglected arthropod-borne infections caused by closely related Borrelia species. They cause mild to deadly undifferentiated fever particularly severe in pregnant women. Lack of a tool to genotype these Borrelia organisms limits knowledge regarding their reservoirs and their epidemiology. METHODOLOGY/PRINCIPAL FINDINGS: Genome sequence analysis of Borrelia crocidurae, Borrelia duttonii and Borrelia recurrentis yielded 5 intergenic spacers scattered between 10 chromosomal genes that were incorporated into a multispacer sequence typing (MST) approach. Sequencing these spacers directly from human blood specimens previously found to be infected by B. recurrentis (30 specimens), B. duttonii (17 specimens) and B. crocidurae (13 specimens) resolved these 60 strains and the 3 type strains into 13 species-specific spacer types in the presence of negative controls. B. crocidurae comprised of 8 spacer types, B. duttonii of 3 spacer types and B. recurrentis of 2 spacer types. CONCLUSIONS/SIGNIFICANCE: Phylogenetic analyses of MST data suggested that B. duttonii, B. crocidurae and B. recurrentis are variants of a unique ancestral Borrelia species. MST proved to be a suitable approach for identifying and genotyping relapsing fever borreliae in Africa. It could be applied to both vectors and clinical specimens.

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.

Abstract Background One of the strategies to promote child health and reduce child mortality is growth monitoring and promotion services. But, there is limited information on determinants of Growth Monitoring and Promotion service utilization. Objective To identify determinants of growth monitoring and promotion (GMP) service utilization among children 0–23 months of age in Legambo district, South Wollo zone, Northern Ethiopia, 2020. Methods Community based un-matched case-control study was conducted on 363 (91 cases and 272 controls) study participants from March 15 to April 15, 2020. A multi-stage sampling technique was employed to select the study participants. Bivariable and multivariable logistic regressions were performed and an adjusted odds ratio with 95% confidence intervals was estimated to identify determinants of GMP service utilization. Results A total of 358 mothers (89 cases and 269 controls) with 98.6% response rate were included in the study. The mean (±SD) age of child was 11.66(±6.29) months among controls and 15.02 (±6.06) months among cases. Good maternal knowledge (AOR) = 2.42; 95% CI: 1.23, 4.75), favorable attitude (AOR = 2.45; 95% CI; 1.20, 4.98), counseling on GMP (AOR = 2.34; 95% CI; 1.19, 4.56), attending ante natal care services (AOR = 2.46; 95% CI: 1.18, 5.16), index child age 12–17 months (AOR = 3.45; 95% CI: 1.26, 9.41) and 18–23 months (AOR = 4.38; 95% CI: 1.53, 12.49), and short distance to health facilities (AOR = 4.53; 95% CI; 1.99, 10.28) were determinants of GMP service utilization. Conclusion Index child age, good knowledge, favorable attitude, attending antenatal care services, receiving nutritional counseling, and a short distance to health facility were determinants of GMP service utilization. Nutritional interventions should emphasize nutritional counseling and accessibility of growth monitoring and promotion services.