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Molla Asnake,1 Suleman Hassen,2 Anteneh Messele,1 Yosef Habtemariam,1 Sisay Mengistu,2 Bizuayehu Tassew,2 Tsegaw Worku,1 Woineab Tadeg1 1Department of Medicine, School of Medicine, College of Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia; 2Department of Surgery, College of Health Sciences, Mizan-Tepi University, Mizan Aman, EthiopiaCorrespondence: Molla Asnake, Email mollaasnake75@gmail.comAbstract: Appendicitis is an inflammation of the vermiform appendix (located near the base of the cecum). A lung abscess is a cavitary lesion containing necrotic lung tissue or an infected fluid component. It mainly occurs as a result of lung parenchymal disease. The patient was a 25-year-old male who first presented with a 1-week history of productive cough and chest pain associated with low-grade fever. He was diagnosed with a lung abscess as a complication of perforated retro cecal appendicitis. We report this in consideration of reducing the challenge of delay in diagnosis of this rare complication, and to avoid mistreatment specifically when the patient’s chest x-ray resembles empyema. Additionally, we encourage doing further studies on this topic.Keywords: lung abscess, sepsis, perforated appendicitis

Sisay Mengistu,1 Molla Asnake,2 Suleman Hassen,1 Biruk Mekonnen2 1Department of Surgery, College of Medicine and health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia; 2School of Medicine, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, EthiopiaCorrespondence: Biruk Mekonnen, School of Medicine, College of Medicine and Health science, Mizan-Tepi University, P.O. Box: 520, Mizan-Aman, Ethiopia, Email birukendalkachew@gmail.comIntroduction: Colonic volvulus is the torsion of a part of the colon causing large bowel obstruction by strangulation, which may lead to ischemia and then necrosis. Synchronous colonic volvulus is extremely rare; even if there are some case reports on synchronous colonic volvulus, there are no reported cases of synchronous ascending and transverse colon volvulus in the medical literature to our knowledge.Case Presentation: A 25-year-old girl with a previous history of epilepsy presented with a one-day duration of abdominal cramps with associated symptoms of vomiting of bilious matter, failure to pass faeces, and flatus of the same duration. The patient underwent surgical intervention, and ascending and transverse volvulus were discovered.Conclusion: In spite of ascending and transverse colon volvulus rarity, we advised including these in the differential diagnosis of patients associated with large bowel obstruction.Keywords: ascending colon, intestinal volvulus, large bowel obstruction, transverse colon

Samuel Tekle Mengistu,1 Oliver Okoth Achila,2 Simon Tesfay Negash,3 Yonathan Tesfaldet,4 Naod Yeibyo Tewolde,5 Nahom Asmerom Yohannes,6 Peniel Tsehaye Embaye,7 Fanus Yemane,3 Beyene Abraha,7 Goitom Hagos,8 Yoseph Tewolde9 1Nakfa Hospital, Ministry of Health Northern Red Sea Branch, Nakfa, Eritrea; 2Department of Clinical Laboratory Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea; 3Adi Keih Hospital, Adi-Keih, Eritrea; 4Akurdet Hospital, Akurdet, Eritrea; 5Ghindae Hospital, Ghindae, Eritrea; 6Gedem Naval Hospital, Gedem, Eritrea; 7Department of Clinical Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea; 8Department of Internal medicine, Orotta College of Medicine and Health Sciences, Asmara, Eritrea; 9Department of Surgery, Orotta College of Medicine and Health Sciences, Asmara, EritreaCorrespondence: Samuel Tekle Mengistu, General Practitioner, Nakfa Hospital, Northern Red Sea Ministry of Health, Nakfa, P.O. Box - 5659, Asmara, Eritrea, Tel +2917535772, Email teklesam7@gmail.comBackground: Provision of high-quality emergency care for acute, life-threatening illnesses can significantly reduce DALY and mortality in sub-Saharan Africa. Here, we present data on the profile of an Emergency Department (ED) in the largest referral hospital in Eritrea and potential gaps for intervention.Patients and Methods: This was a prospective single-center observational study of 1093 patients who presented to the ED between September and October of 2020. Data were collected using a questionnaire from the patients’ interview, observation and medical record review. The data were summarized using descriptive statistics and where applicable logistic regressions were performed.Results: The median age was 45.0 years among the patients. In terms of acuity, 741 (68.5%), 283 (26.2%), 48 (4.4%), 10 (0.9%) patients were triaged as green, yellow, red, and black, respectively. In addition, the number of self-referred patients was 857 (79.1%) and among all the visitors, 376 (34.9%) used Ambulance service. The median ± IQR for ED length of stay (LOS) was 2.7 (1.4– 10.0) Hours. Further, 154 (14.4%) patients stayed in the ED for > 24 hours. The hospitalization rate was 146 (14.7%). In the multivariate analysis, higher likelihood of prolonged ED LOS was observed in: medical department patients (aOR = 3.53, 95% CI = 2.03– 6.14); patients referred from primary health-care centers (aOR = 2.63, 95% CI = 1.10– 6.30) and hospital (aOR = 3.70, 95% CI = 2.15– 6.37). Prolonged ED LOS was also associated with prior emergency visit (aOR = 1.96, 95% CI = 1.13– 3.40); consultation (aOR = 12.27, 95% CI = 6.98– 21.56); the need for inpatient admission (aOR = 2.34, 95% CI = 1.38– 3.96); and the need for investigation and treatment (aOR = 2.03, 95% CI = 1.07– 3.85).Conclusion: Improvements regarding ED specialist personnel, inpatient ward capacity, availability of investigations throughout the day and night shifts, amendments in referral system, strengthening ED and critical care capacity in zonal referral hospitals, and access to quality care among the non-communicable disease patients may ameliorate most of the bottlenecks observed in this set-up.Keywords: emergency department, ED LOS, emergency medical services systems, Eritrea, Sub-Saharan Africa, chief complain

Recent growth in the capabilities of unmanned aerial vehicles and systems (UASs) as airborne platforms for collecting environmental data has been very rapid. There are now ample examples in the literature of UASs being deployed to map fine-scale vegetation, glacial, soil and atmospheric conditions. The purported advantages of UASs are their ability to collect spatial data at lower cost, lower risk, higher resolution and higher frequency than ground surveys or satellite platforms. In this specific study, whether or not obtaining high-resolution UAS imagery was advantageous for identifying an intermittent stream network was determined by comparing it with coarse-scale satellite imagery collected for the same purpose. It was also determined if the UAS imagery could be an improvement to Global Positioning System acquired ground-truth points for classifying an intermittent stream network across the same large-scale satellite image. The UAS-acquired and satellite-acquired imageries were derived from a visible spectrum camera capable of 2-cm resolution and multispectral SPOT-5 with 10-m resolution, respectively. The SPOT-5 imagery with its relatively coarse resolution could not always detect the narrow intermittent stream, which was well resolved in the UAS imagery. When a classified UAS image was applied as a training area for the SPOT-5 image, the identification of the stream network and accuracy of the satellite imagery classification did not necessarily improve. UASs have the potential to revolutionize hydrological research the same way that geographic information systems did three decades ago. A final goal of the paper is to provide insight into the advantages and disadvantages of deploying a UAS for this kind of research. © 2015 Her Majesty the Queen in Right of Canada. Hydrological Processes. © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Dextrose was produced from locally available hybrid variety of maize (Bako Hybrid-660) in Ethiopia, using acid extraction. The variety was selected as an experimental input from Bako Agricultural Research Centre for the production of intermediate product starch using wet milling and end-product dextrose. The proximate composition values in the wet, milled, dried and cleaned white dent 2000 g BH-660 maize when steeped in 0.3% sulfur dioxide for 46 hrs at 50oC were determined. The mean values were 11.74%, 64.15%, 4.51%, 10.23%, 6.53% and 2.81%, for moisture content, total starch, germ, gluten, husk and fibre, respectively on dry weight basis. The total starch obtained from wet milling was 91.8% pure starch by mass. The proximate analysis values of moisture, crude protein, crude fat, crude fibre and total ash content of the sample were 7.65 %, 4.89%, 0.35%, 0.75 % 0.29 % , respectively on dry weight basis. Besides these, pH value was also determined to be 4.79. This obtained starch was hydrolyzed by an acid extraction method for the production of BH-660 maize dextrose. An average yield of 91.64% dextrose result was obtained and from this, 92.24% was pure dextrose by mass. Analysis result revealed that moisture, crude protein, crude fat, crude fibre and total ash content of the produced dextrose were 6.24%, 0.11%, 0.25%, 0.30% and 0.03%, respectively on dry weight basis. In addition, the pH value of 6.28 was determined. The control dextrose obtained from Ethiopian Pharmaceutical Manufacturing Share Company analysis values of moisture, crude fibre, crude fat and dextrose content were 5%, 0.24%, 0.23% and 93.73%, respectively on dry weight basis. From these data, it can be concluded that the BH-660 maize variety has a significant potential for the production of high quality starch and dextrose, which can be used as a raw material for starch and dextrose processing industries. [ABSTRACT FROM AUTHOR]

Cereal finger millet (Eleusine coracana (L.) Gaertn) is one of the most promising vital crops of Asia and Africa in the face of climate change. It has a capacity to adapt to extreme environmental conditions and can be grown under a wide range of wider agroecology. It is believed to be originated in the highlands of Ethiopia and then disseminated across the globe. It is mainly cultivated as dietary staple food for humans, animal feeds and also used as medicinal crop. Though finger millet is recognized as the most important staple crop, particularly for the poor people in dry and semidry areas, it has been neglected and given little concern in mainstreaming the crop for its improvement research.

Background: There has been a paucity of evidence for the development of a prediction model for diabetic retinopathy (DR) in Ethiopia. Predicting the risk of developing DR based on the patient's demographic, clinical, and behavioral data is helpful in resource-limited areas where regular screening for DR is not available and to guide practitioners estimate the future risk of their patients., Methods: A retrospective follow-up study was conducted at the University of Gondar (UoG) Comprehensive Specialized Hospital from January 2006 to May 2021 among 856 patients with type 2 diabetes (T2DM). Variables were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. The data were validated by 10-fold cross-validation. Four ML techniques (naïve Bayes, K-nearest neighbor, decision tree, and logistic regression) were employed. The performance of each algorithm was measured, and logistic regression was a well-performing algorithm. After multivariable logistic regression and model reduction, a nomogram was developed to predict the individual risk of DR., Results: Logistic regression was the best algorithm for predicting DR with an area under the curve of 92%, sensitivity of 87%, specificity of 83%, precision of 84%, F1-score of 85%, and accuracy of 85%. The logistic regression model selected seven predictors: total cholesterol, duration of diabetes, glycemic control, adherence to anti-diabetic medications, other microvascular complications of diabetes, sex, and hypertension. A nomogram was developed and deployed as a web-based application. A decision curve analysis showed that the model was useful in clinical practice and was better than treating all or none of the patients., Conclusions: The model has excellent performance and a better net benefit to be utilized in clinical practice to show the future probability of having DR. Identifying those with a higher risk of DR helps in the early identification and intervention of DR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: One of the most important health interventions for reducing maternal morbidity and death is the use of maternal healthcare services. In Ethiopia, maternal healthcare services are not well utilized, particularly in rural pastoralist communities, despite their significance. Therefore, the purpose of this study was to evaluate the use of maternal healthcare services and the characteristics that are related to it in the East Borena zone. Techniques: In September 2020, a community-based cross-sectional survey was carried out in Liben with 416 randomly selected mothers. Mothers who had given birth within the 12 months before the study comprised the respondents. Questionnaires given by interviewers were used to gather the data. The data were transferred to SPSS version 20 for analysis after being entered into Epi-Info version 4.1 for coding. The Kolmogorov-Smirnov, Hosmer, and Lemeshow goodness of fit tests were employed, along with descriptive statistics. Additionally, multivariate and binary logistic regression analyses were carried out. 95% CI and the odd ratio were used to examine the relationship between the outcome and predictive variables., Results: At least one prenatal visit was received by 60% of moms. Only 21.2% and 17.5% of women had given birth in a medical facility and made use of early postnatal care services. The use of antenatal care was strongly correlated with maternal education [AOR = 2.43 (95% CI: 1.22-4.89)], decision-making capability [AOR = 2.40 (95% CI: 1.3-23.3)], felt compassionate and respectful treatment [AOR = 0.30 (95% CI: 0.18-0.50)], and intended current pregnancy [AOR = 0.22 (95% CI: 0.12-0.37)]. Moms b/n ages 15-19 had a 3.7-fold higher probability of giving birth in a hospitals than moms b/n ages 35 and 49 [AOR = 1.74 (95% CI: 1.02-3.08)]. Mothers who lived far away were 1.02 times less likely to give birth at a hospital than those who could reach one within an hour (AOR = 1.74;95% CI: 1.02, 3.08). While recent use of antenatal care [AOR = 5.34 (95% CI: 1.96-8.65)], planned current pregnancy, and knowledge of using postnatal care were shown to be strongly correlated with danger indicators [AOR = 2.93 (95% CI: 1.59-5.41)], knowledge of danger signs [AOR = 3.77 (95% CI: 2.16-6.57)] and perceived compassionate and respectful care were significantly associated with institutional delivery., Conclusion: Overall the prevalence of maternal healthcare services utilization was far below the national and regional targets in the study area. Thus, promoting institutional services, raising community knowledge, empowering women to make decisions, and enhancing the infrastructure of the health sector., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Desta, Mengistu and Arero.)

Background: Professional licensing bodies are valuable sources for tracking the health workforce, as many skilled health-care providers require formal training, registration, and licensure. Regulatory activities in Ethiopia were not effectively implemented due to poor follow-up and gaps in skilled human resources, budget, and information technology infrastructure., Objective: The aim of this study was to explore and describe the lived experiences and challenges faced by health care managers in health professionals' licensure practices in Ethiopia., Methods: A cross-sectional study design with a phenomenological approach was employed between March 26 and April 30, 2021, to collect qualitative data. We conducted in-depth interviews with a total of 32 purposively selected health system managers. An interview guide was prepared in English, translated into Amharic, and then pretested. Audio recorded data was transcribed verbatim, translated, and analysed manually by themes and sub-themes. A member check was done to check the credibility of the result., Results: The data revealed four major themes: awareness of licensing practices, enforcement of licensing practices, systems for assuring the quality of licensing practices, and challenges to licensing practices. Lack of awareness among managers about health workforce licensing was reported, especially at lower-level employers. Regulators were clear on the requirements to issue a licence to the health workforce if they are competent in the licensing exam, while human resource managers do not emphasise whether the employees have a licence or not during employment. As a result of this, non-licenced health workers were employed. Health care managers mentioned that they did not know any monitoring tools to solve the issue of working without a licence. Fraudulent academic credentials, shortage of resources (human resources, finance, equipment, and supplies), and weak follow-up and coordination systems were identified as main practice challenges., Conclusions: This study reported a suboptimal health professionals' licensing practice in Ethiopia, which is against the laws and proclamations of the country that state to employ all health workers only with professional licenses. Challenges for health professionals' licensing practice were identified as fraudulent academic credentials, a shortage of resources (HR, finance, equipment, and supplies), and a weak follow-up and coordination system. Further awareness of licensing practices should be created, especially for lower-level employers. Regulators shall establish a reliable digital system to consistently assure the quality of licensing practices. Health care managers must implement mechanisms to regularly monitor the licensing status of their employees and ensure that government requirements are met. Collaboration and regular communication between regulators and employers can improve quality practices., Competing Interests: There is no competing interest among the authors., (Copyright: © 2024 Teka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Repeat-induced abortion is the termination of pregnancy for more than one time using drugs or surgical intervention before the fetus reaches the age of viability. This study aimed to estimate the pooled prevalence of repeat-induced abortion and its determinants among women in Ethiopia., Materials and Methods: PubMed, HINARI and Google Scholar were systematically searched for eligible studies. A random effect model was used to estimate the pooled prevalence. The Cochrane Q-statistics and I 2 tests were used to assess heterogeneity between included studies., Results: The estimated pooled prevalence of repeat-induced abortion was 30.89% (95% CI: 28.88-32.91). Alcohol consumption (POR = 3.60, 95%CI: 2.26-5.74), assuming the procedure painless (POR = 2.79, 95%CI: 1.77-4.39), no fertility awareness (POR = 3.45, 95% CI: 1.05-11.36), and women with multiple sexual partners (POR = 4.31, 95% CI: 3.36-5.53) were significantly associated with repeat-induced abortion., Conclusion: The study revealed that about one in ten women who had a history of abortion experienced repeat-induced abortion. Alcohol consumption, no fertility awareness, assuming the procedure is painless, and having multiple sexual partners were significantly associated with repeat-induced abortion., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier Ltd.)

Objective: Obstetric fistula repair failure is a combination of unsuccessful fistula closure and/or incontinence following a successful closure. There is an inconsistent finding on the failure of obstetric fistula repair in East Africa. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of failed obstetric fistula repair and its associated factors among women who have undergone fistula repair in East Africa., Methods: This systematic review and meta-analysis were written following the PRISMA guideline protocol. A web-based electronic search of PubMed, Google Scholar, and HINARI was performed to find primary studies. Additional articles were searched by cross-referencing references. A random-effects model was used to estimate the pooled prevalence of failed obstetric fistula repair. The heterogeneity of studies was weighed using I 2 test statistics. Publication bias was assessed by Eggers and funnel plot test., Results: The 16 studies that met the inclusion criteria for this systematic review and meta-analysis of failed obstetric fistula repair were included. Nonetheless, one study was used for factor analysis but not in pooled prevalence analysis. The pooled prevalence of obstetric fistula repair failure in East Africa was 26.89% (95% confidence interval: 21.71, 32.07). Labor duration > 48 h (Pooled odds ratio = 2.46; 95% confidence interval 1.58, 3.82), fistula size >3 cm (Pooled odds ratio = 3.92; 95% confidence interval 2.19, 7.05), previous fistula repair (Pooled odds ratio = 3.20; 95% confidence interval 1.94, 5.29), Goh Type 4 fistulas (Pooled odds ratio = 6.07; 95% confidence interval 2.50, 14.75), completely destructed urethra (Pooled odds ratio = 3.35; 95% confidence interval 1.69, 6.65), and severe vaginal scaring (Pooled odds ratio = 3.89; 95% confidence interval 1.99, 7.62) were significantly associated with obstetric fistula repair failure., Conclusions: One in four women with obstetric fistula repair experienced repair failure. To fight the problem The Ministry of Health in every part of the country, in collaboration with obstetric care providers, shall intervene on factors affecting obstetric fistula repair failure to reduce or prevent the failure of obstetric fistula repair., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Successful linkage to HIV services and initiation of antiretroviral treatment (ART) for children living with HIV (CLHIV) is critical to improve pediatric ART coverage. We aimed to assess confirmatory testing, linkage, and rapid ART initiation among newly diagnosed CLHIV in Ethiopia from the perspectives of caregivers and healthcare workers (HCWs)., Methods: We conducted standardized surveys with HCWs and caregivers of children 2-14 years who were diagnosed with HIV but not yet on ART who had been identified during a cross-sectional study in Ethiopia from May 2017-March 2018. Eight health facilities based on their HIV caseload and testing volume and 21 extension sites were included. Forty-one children, 34 care givers and 40 healthcare workers were included in this study. Three months after study enrollment, caregivers were surveyed about timing and experiences with HIV service enrollment, confirmatory testing, and ART initiation. Data collected from HCWs included perceptions of confirmatory testing in CLHIV before ART initiation. SPSS was used to conduct descriptive statistics., Results: The majority of the 41 CLHIV were enrolled to HIV services (n = 34, 83%) and initiated ART by three months (n = 32, 94%). Median time from diagnosis to ART initiation was 12 days (interquartile range 5-18). Five children died before the follow-up interview. Confirmatory HIV testing was conducted in 34 children and found no discordant results; the majority (n = 23, 68%) received it within one week of HIV diagnosis. Almost all HCWs (n = 39/40, 98%) and caregivers (n = 31/34, 91%) felt better/the same about test results after conducting confirmatory testing., Conclusion: Opportunities remain to strengthen linkage for newly diagnosed CLHIV in Ethiopia through intensifying early follow-up to ensure prompt confirmatory testing and rapid ART initiation. Additional services could help caregivers with decision-making around treatment initiation for their children., (© 2022. The Author(s).)

Background: Evidence suggests that not all human resource departments have hired their facility staff based on federal licensing standards, with some hiring without an active license. This is common in some, if not all, parts of the country. The paucity of healthcare experts, high turnover rates, employee burnout, and challenges in training and development issues were all key recruiting challenges globally., Objective: To assess the practice of health professionals' licensing and its predictors among hiring bodies in Ethiopia, March 24/2021-May 23/2021., Methods: A cross-sectional study was conducted in privately and publicly funded health facilities throughout Ethiopia. For each region, a stratified sampling strategy was utilized, followed by a simple random sampling method. Documents from the recruiting bodies for health professionals were reviewed. A pretested structured questionnaire and document review tool were used to extract data confidentially. A descriptive analysis of the basic hiring body characteristics was conducted. Hiring body characteristics were analyzed in bivariate and multivariate logistic regression to identify factors associated with best health professionals licensing practice. Data management and analysis were conducted with Epi-Data version 4.4.3.1 and SPSS version 23, respectively., Results: The analysis included 365 hiring bodies and 4991 files of health professionals (1581 from private and 3410 from public health organizations). Out of 365 hiring bodies studied, 66.3% practiced health professional licensing. A total of 1645 (33%) of the 4991 professionals whose files were reviewed were found to be working without any professional license at all. Furthermore, about 2733 (55%) have an active professional license, and about 603 (12%) were found to work with an expired license. Being a private facility (adjustedOR = 21.6; 95% CI = 8.85-52.55), obtaining supervision from a higher organ (adjustedOR = 19.7; 95%CI: 2.3-169.1), and conducting an internal audit (adjustedOR = 2.7; 95% CI: 1.15-6.34) were predictors of good licensing practice., Conclusions: The licensing of health practitioners was poorly practiced in Ethiopia as compared to the expected proclamation of the country. A system for detecting fake licenses and controlling revoked licenses does not exist in all regions of the country., (© 2022. The Author(s).)

Background: People with pre-existing chronic diseases are more likely to acquire COVID-19 infections, which can be fatal, and die from COVID-19 illness. COVID-19 vaccination will benefit those at a higher risk of developing complications and dying from the disease. This study aimed to determine chronic patients' willingness to receive a COVID-19 vaccine and the factors that influence their willingness., Method: An institutional-based cross-sectional study was conducted among 423 adult chronic patients in the University of Gondar specialized hospital outpatient departments. The participants were chosen using systematic random sampling methods with an interval of 5. Face-to-face interviews were used to collect data from eligible respondents. Epi-data version 4.6 and SPSS version 25 were used for the data entry data analysis. Bivariable and multivariable binary logistic regression analyses were used to evaluate the relationship between the dependent and independent factors. An odds ratio with 95 percent confidence intervals and a P-value was used to determine the association's strength and statistical significance., Result: Out of 401 respondents, 219 (54.6%) with [95% CI (49.7-59.5%)] of study participants were willing to receive the COVID-19 vaccination. Being a healthcare worker (AOR = 2.94, 95% CI: 1.24-6.96), Lost family members or friends due to COVID-19 (AOR = 2.47, 95% CI: 1.21-5.00), good knowledge about COVID-19 vaccine (AOR = 2.44, 95% CI: 1.37-4.33), favorable attitude towards COVID-19 vaccine (AOR = .8.56 95% CI: 4.76-15.38), perceived suitability of the COVID-19 infection (AOR = 2.94, 95% CI: 1.62-5.33) and perceived benefit of the COVID-19 vaccine (AOR = 1.89, 95% CI: 1.08-3.31), were found to be a significant association with the willingness to receive the COVID-19 vaccine among chronic patients., Conclusion: This study confirms that around 55% of adult chronic patients were willing to receive the COVID-19 vaccine. Providing health education for chronic patients to emphasize the knowledge and attitude of the COVID-19 vaccine and raise patients' perceived risk of COVID-19 and the benefit of the COVID-19 vaccine could be recommended to improve their willingness to COVID-19 vaccination., Competing Interests: The authors have declared that no competing interests exist.

Background: Antibiotics are among the most widely used drugs in farm animals for therapeutic and prophylactic purposes. However, the antibiotic residues in meat are a serious public health concern due to their harmful effects on consumer health. Besides this problem, there is limited information on the level of the antibiotic residues, including tetracycline residues. Therefore, this study was aimed to determine the tetracycline residues in the kidney and muscle samples of beef cattle in Harar town and Dire Dawa city., Methods: A study was conducted on 500 randomly selected carcass (250 kidney and 250 muscle samples) slaughtered at Dire Dawa and Harar municipal slaughterhouses between December 2018 and December 2019. The samples were collected aseptically and screened for tetracycline residues by thin layer chromatography. Then, presumptive positive samples were analyzed using high-performance liquid chromatography to get a quantitative outcome. Descriptive statistics were used to determine the frequency, mean, or standard deviation to determine the summary values and distribution of the outcomes. Finally, the data was analyzed using SPSS version 21 software., Results: Out of 500 samples, oxytetracycline residues were detected in 84% of the samples. However, tetracycline and doxycycline were not detected in all samples. Among the kidney and muscle samples collected from Dire Dawa and Harar abattoirs, 109 (87.2%) and 101 (80.8%) were positive for oxytetracycline, respectively. Oxytetracycline residue levels in Dire Dawa ranged from 57 to 607 µg/kg for the kidney and 10.14 to 435 µg/kg for muscle samples. Among the samples collected from Harar, the concentration of oxytetracycline residues ranged from 16 to 433 µg/kg and 6 to 435 µg/kg for kidney and muscle samples, respectively, at Harar slaughterhouses. About 22.0% of muscle samples collected from Dire Dawa and 17.8% from Harar town had oxytetracycline residues above maximum residue limits., Conclusions: In general, the study revealed that oxytetracycline residues were prevalent among tetracycline residues analyzed from kidney and muscle samples in the study areas. Thus, there is a risk of consumer exposure to these antibiotic residues that may have human health effects. Therefore, awareness creation and strict regulation is needed by the regulatory authorities for the use of antimicrobial drugs in the livestock industry., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Organic matter and some selected metals (As, Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Pb, and Zn) were measured from water and sediment while plant samples from the inlet to the outlet sampling sites using standard procedures from three compartments (water, sediment, and macrophytes) of Yitamot wetland. Findings indicated that the mean concentration of COD in water was in the range of 5.25 mg/L and 208.25 mg/L and showed a significant and exponential decrease along the subsequent sampling sites ( P < 0.05). The mean concentrations of K, As, Cd, and Cr (82.192 mg/kg, 0.730 mg/kg, 0.06 mg/kg, and 19.776 mg/kg, respectively) were significantly lower values in the outlet than in the inlet of the sediment samples ( P < 0.05). All the metal concentrations in the aboveground tissue of macrophytes were significantly lower at the outlet sample site ( P < 0.05) indicating that these compartments are contributing to the retention of metals and organic matter present in wastewater discharged in the wetland through sinks and conversions of these compounds. However, there was no significant removal effect for heavy metals like Fe, Zn, and As ( P > 0.05). This is a pointer to the fact that natural wetlands can be used effectively for wastewater treatment with strong monitoring programs and ecological indicators for the sustainable management and conservation of the flora and fauna present in it., Competing Interests: It is declared that the authors neither have any conflict of interests nor financial gain for this paper., (Copyright © 2022 Yezbie Kassa et al.)

Background: Implementing effective and efficient case-finding strategies is crucial to increasing pediatric antiretroviral therapy coverage. In Ethiopia, universal HIV testing is conducted for children presenting at high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC); however, low positivity rates observed at inpatient, malnutrition and OVC entry points warrant re-assessing current case-finding strategies. The aim of this study is to develop HIV risk screening tool applicable for testing children presenting at inpatient, malnutrition and OVC entry points in low-HIV prevalence settings., Methods: The study was conducted from May 2017-March 2018 at 29 public health facilities in Amhara and Addis Ababa regions of Ethiopia. All children 2-14 years presenting to five high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC) were enrolled after consent. Data were collected from registers, medical records, and caregiver interviews. Screening tools were constructed using predictors of HIV positivity as screening items by applying both logistic regression and an unweighted method. Sensitivity, specificity and number needed to test (NNT) to identify one new child living with HIV (CLHIV) were estimated for each tool., Results: The screening tools had similar sensitivity of 95%. However, the specificities of tools produced by logistic regression methods (61.4 and 65.6%) which are practically applicable were higher than those achieved by the unweighted method (53.6). Applying these tools could result in 58‒63% reduction in the NNT compared to universal testing approach while maintaining the overall number of CLHIV identified., Conclusion: The screening tools developed using logistic regression method could significantly improve HIV testing efficiency among children presenting to malnutrition, inpatient, and OVC entry points in Ethiopia while maintaining case identification. These tools are simplified to practically implement and can potentially be validated for use at various entry points. HIV programs in low-prevalence countries can also further investigate and optimize these tools in their settings., (© 2022. The Author(s).)

Background: Stillbirth, which accounts for half of all the perinatal mortality, is not counted on policy, program, and investment agendas around the globe. It has been underestimated public health burden, particularly in developing countries. Ethiopia is among the top countries with a large prevalence of stillbirth in the world. However, there is a dearth of study on the current magnitude of stillbirth in the study area. Therefore, this study intended to assess the prevalence of stillbirth and its associated factors to bridge the gap., Methods: A hospital-based retrospective study was conducted from 1 to 28 February 2019 and data were collected by reviewing the chart records of all the women who gave birth in the past 2 years (January 2016 to December 2018) at Hiwot Fana Specialized University Hospital. Data were entered into EpiData version 4.2.0.0 software and transported to SPSS version 23 for analysis. Descriptive statistics such as frequency, mean, and SDs were generated. Determinants of stillbirth were analyzed using a binary logistic regression and presented by adjusted odds ratio (AOR) with a 95% CI., Results: The prevalence of stillbirth was 14.5% (95% CI: 11.7%, 17.6%). Low birth weight (AOR = 2.42, 95% CI: 1.23-4.76), prematurity (AOR = 2.10, 95% CI: 1.10-4.01), premature rupture of membranes (AOR = 2.08, 95% CI: 1.14-3.77), antepartum hemorrhage (AOR = 3.33, 95% CI: 1.66-6.67), obstructed labor (AOR = 2.87, 95% CI: 1.48-5.56), and preeclampsia (AOR = 2.91, 95% CI: 1.28-6.62) were an independently associated with stillbirth., Conclusion: The prevalence of stillbirth in this study was high. Low birth weight, preterm birth, premature rupture of membranes, antepartum hemorrhage, obstructed labor, and preeclampsia were independently associated with a stillbirth. Therefore, much study is needed involving different stakeholders to reduce stillbirths by improving the health status of women through the provision of quality maternal care including referral systems., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mengistu, Debella, Mulatu, Mesfin, Danusa and Dheresa.)

Allium species including garlic and leek exhibits a broad range of medicinal and nutritional properties. Therefore, this study investigates the physicochemical and biological activities of garlic ( Allium sativum L.) and leek ( A. ampeloprasum L. var. Porrum ) oil extracts. The result indicated that physicochemical properties indicated that significantly higher oil yield (21.25%), ACV (2.66 mg/g), FFA (1.34%), and PV (4.10 meq/kg) and also antioxidant activities with respect to 2, 2-diphenyl-1-picrylhydrazyl, DPPH (27.60 ± 1.55%), hydrogen peroxide (12.35 ± 0.92%) free radical scavenging activities, and ascorbic acid content (25.30 ± 3.25%) were obtained for leek leaf oil extract. Stronger antibacterial activity with a maximum zone of inhibition (16.00 mm), minimum inhibitory concentration (MIC) (0.20  µ g/ml), and minimum bactericidal concentration (MBC) (0.40  µ g/ml) was recorded for leek oil extract against S. pyogenes . However, garlic oil has presented stronger antifungal activity with a maximum zone of inhibition (13.50 mm), MIC (0.40  µ g/ml), and minimum fungicidal concentration (MFC) (0.75  µ g/ml) against Candida albicans. It is concluded from the results of this investigation that oils extracts of garlic bulb and leek leaves demonstrated significant biological activities that can be used as sources for pharmaceutical and nutraceutical ingredients., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Elias Lemma et al.)

Background: Limited data in low HIV prevalence settings such as Ethiopia limit policy development and implementation of optimized pediatric testing approaches to close the treatment gap. This study aimed to determine HIV prevalence, testing yield and factors associated with HIV among children at 5 entry points., Methods: We conducted a cross-sectional study from May 2017 to March 2018 in 29 public health facilities in Amhara and Addis Ababa regions in Ethiopia. Children 2-14 years were enrolled through 5 entry points. Data were obtained from registers, medical records and interviews with caregivers. HIV prevalence and testing yields were calculated for each entry point. Mixed-effects logistic regression analysis identified factors associated with undiagnosed HIV., Results: The study enrolled 2166 children, of whom 94 were HIV positive (40 newly diagnosed). HIV prevalence and testing yield were the highest among children of HIV-positive adults (index testing; 8.2% and 8.2%, respectively) and children presenting to tuberculosis clinics (7.9% and 1.8%) or with severe malnutrition (6.5% and 1.4%). Factors associated with undiagnosed HIV included tuberculosis or index entry point [adjusted odds ratio (aOR), 11.97; 95% CI 5.06-28.36], deceased mother (aOR 4.55; 95% CI 1.30-15.92), recurrent skin problems (aOR 17.71; 95% CI 7.75-40.43), severe malnutrition (aOR 4.56; 95% CI 2.04-10.19) and urban residence (aOR 3.47; 95% CI 1.03-11.66)., Conclusions: Index testing is a critical strategy for pediatric case finding in Ethiopia. Strategies and resources can prioritize minimizing missed opportunities in implementing universal testing for very sick children (tuberculosis, severe malnutrition) and implementing targeted testing in other entry points through use of factors associated with HIV., Competing Interests: This research was supported by the US President’s Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention under the terms of Cooperative Agreement No. 1U2GGH001039. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies. The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The global lockdown to mitigate COVID-19 pandemic health risks has altered human interactions with nature. Here, we report immediate impacts of changes in human activities on wildlife and environmental threats during the early lockdown months of 2020, based on 877 qualitative reports and 332 quantitative assessments from 89 different studies. Hundreds of reports of unusual species observations from around the world suggest that animals quickly responded to the reductions in human presence. However, negative effects of lockdown on conservation also emerged, as confinement resulted in some park officials being unable to perform conservation, restoration and enforcement tasks, resulting in local increases in illegal activities such as hunting. Overall, there is a complex mixture of positive and negative effects of the pandemic lockdown on nature, all of which have the potential to lead to cascading responses which in turn impact wildlife and nature conservation. While the net effect of the lockdown will need to be assessed over years as data becomes available and persistent effects emerge, immediate responses were detected across the world. Thus, initial qualitative and quantitative data arising from this serendipitous global quasi-experimental perturbation highlights the dual role that humans play in threatening and protecting species and ecosystems. Pathways to favorably tilt this delicate balance include reducing impacts and increasing conservation effectiveness., Competing Interests: Authors declare no competing interests., (© 2021 Published by Elsevier Ltd.)

Background: Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system. In 2010, Ethiopia established a national authority aiming to ensure competence and ethics of health professionals. Subsequently, subnational regulators were established and regulatory frameworks were developed. Although there were anecdotal reports of implementation gaps, there was lack of empirical evidence to corroborate the reports. We conducted a national study to explore health professional regulation practices and gaps focusing on registration, licensing, ethics, scope of practice, and continuing professional development., Methods: We conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers. We used two stage stratified cluster sampling to select health professionals. The quantitative data were subjected to descriptive and multivariable logistic regression analysis. We conducted thematic analysis of the qualitative data., Results: We interviewed 554 health professionals in the quantitative survey. And 31 key informants participated in the qualitative part. Nearly one third of the respondents (32.5%) were not registered. Many of them (72.8%) did not renew their licenses. About one fifth of them (19.7%) did nothing against ethical breaches encountered during their clinical practices. Significant of them ever practiced beyond their scope limits (22.0%); and didn't engage in CPD in the past 1 year (40.8%). Majority of them (97.8%) never identified their own CPD needs. Health regulators and managers stressed that regulatory bodies had shortage of skilled staff, budget and infrastructure to enforce regulation. Regulatory frameworks were not fully implemented., Conclusions: Health professionals were not regulated well due to limited capacity of regulators. This might have affected quality of patient care. To ensure effective implementation of health professional regulation, legislations should be translated into actions. Draft guidelines, directives and tools should be finalized and endorsed. Capacity of the regulators and health facilities needs to be built. Reinstituting health professionals' council and regulation enforcement strategies require attention. Future studies are recommended for assessing effects and costs of weak regulation., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2019.)

A cross-sectional study was conducted to estimate the prevalence of Staphylococcus aureus in raw milk and swab, to assess the antimicrobial susceptibility profile, milk handling practice, and its associated risk factors in selected dairy farms of Mukaturi and Sululta Town, Oromia Region, Ethiopia. A total of 247 samples collected from dairy farms were examined using standard microbiological techniques. The antimicrobial susceptibility profiles of the isolates were also investigated. The possible risk factors for Staphylococcus aureus contaminations in milk were evaluated through a structured questionnaire. Overall, 16.6% (n= 41) of the samples were positive for S. aureus . The prevalence of S. aureus was 15.3% from udder milk and 25%, 20%, and 10% from milkers' hand, milking bucket, and drying towel swab, respectively. The prevalence of Staphylococcus aureus in milk showed statistically significant variation with respect to age (p≤ 0.001), parity (P≤ 0.001), drainage condition of milking area (P=0.035), study sites (P=0.035), and management system (P=0.035). Majority of the isolates were found resistant to penicillin G (97.6%) and amoxicillin (43.9%). According to this study, 12/28(42.9%) Staphylococcus aureus positive raw milk samples had 10 4 -10 5 cfu/ml S. aureus count, which is above the recommended level for human consumption. 47.1% of milking persons store milk at room temperature temporarily (between 6 and 12 hrs) till transport to collection center with no means of cooling aid. From consumers 25.6% had no health risk associated with raw milk consumption or aware of milk borne disease associated with drinking raw milk. Thus, 60.5% of milk users had habit of raw milk consumption. The study revealed a prevalence of S. aureus , poor milk handling practices, raw milk consumption behavior in study area. Proper handling and hygiene decrease milk contamination by S. aureus and make it safe for human consumption., Competing Interests: The authors declare that there is no conflict of interests.

Wetlands have the capacity to retain nitrogen and phosphorus and are thereby often considered a viable option for improving water quality at local scales. However, little is known about the cumulative influence of wetlands outside of floodplains, i.e., non-floodplain wetlands (NFWs), on surface water quality at watershed scales. Such evidence is important to meet global, national, regional, and local water quality goals effectively and comprehensively. In this critical review, we synthesize the state of the science about the watershed-scale effects of NFWs on nutrient-based (nitrogen, phosphorus) water quality. We further highlight where knowledge is limited in this research area and the challenges of garnering this information. On the basis of previous wetland literature, we develop emerging concepts that assist in advancing the science linking NFWs to watershed-scale nutrient conditions. Finally, we ask, "Where do we go from here?" We address this question using a 2-fold approach. First, we demonstrate, via example model simulations, how explicitly considering NFWs in watershed nutrient modeling changes predicted nutrient yields to receiving waters-and how this may potentially affect future water quality management decisions. Second, we outline research recommendations that will improve our scientific understanding of how NFWs affect downstream water quality.

Background: A high performing physician workforce is critical to attain nationally set health sector goals. Ethiopia has expanded training of medical doctors. However, little is known about junior doctors' performance. Understanding medical practice is essential to inform medical education and practice, establish licensure examination and guide workforce management decisions. We conducted a practice analysis study to identify gaps in Ethiopian medical education and practice, and to determine composition of subjects in national licensing examination., Methods: We conducted a cross-sectional study with national representative sample of junior doctors. After calculating a sample size of 198, we used a two-stage stratified cluster sampling method to select study participants. We collected data using a structured questionnaire comprising 222 tasks. Study participants reported in interviews on frequency of, competence at, and importance of doing each task for improved health outcome. We developed proportions, averages, graphs and tables. Using the results of practice analysis and experts' ratings, relative weights of subjects in the national licensing examination for medical undergraduates were determined., Results: A total of 191 junior doctors participated. Most were males (74.6%) and had less than 2 years of experience (69.8%). Junior doctors frequently performed tasks of internal medicine and pediatrics. Their participation in obstetrics and gynecology, ophthalmology, psychiatry and dentistry services was infrequent. Junior doctors had competency gaps to conduct clinical procedures, research and health programming tasks. Practice analysis results and expert ratings generated comparable recommendations for composition of a national licensing examination, with more than three-quarters of the items focusing on internal medicine, pediatrics, surgery, obstetrics and gynecology, and public health., Conclusion: Junior doctors in Ethiopia rarely managed psychiatry, ophthalmology and dental patients. They had competence gaps in clinical procedures, research and health programming skills. The findings have implications for establishing licensing examination, and reviewing curriculum, continuing professional development, placement and rotation policy, and distribution of responsibilities., Competing Interests: Authors declare that the study was conducted after securing ethical clearance from Johns Hopkins School of Public Health IRB, and obtaining consent from study participants.Not applicableThe authors declare that they have no competing interest.

Root-rats of the genus Tachyoryctes (Spalacidae) are subterranean herbivores occupying open humid habitats in the highlands of Eastern Africa. There is strong disagreement about species diversity of the genus, because some authors accept two species, while others more than ten. Species with relatively high surface activity, the giant root-rat Tachyoryctes macrocephalus, which is by far largest member of the genus, and the more fossorial African root-rat Tachyoryctes splendens, which eventually has been divided up to 12-13 species, represent two major morphological forms within the genus. In our study, we carried out a multilocus analysis of root-rats' genetic diversity based on samples from 41 localities representing most of Tachyoryctes geographic distribution. Using two mitochondrial and three nuclear genes, we found six main genetic clades possibly representing separate species. These clades were organised into three basal groups whose branching is not well resolved, probably due to fast radiation in the late Pliocene and early Pleistocene. Climatic changes in that time, i.e. fast and repeated changes between extremely dry and humid conditions, which both limited root-rat dispersal, probably stimulated their initial genetic diversification. Contrary to expectation based on the largest root-rat diversity in Kenya (up to eight species by some authors), we found the highest diversity in the Ethiopian highlands, because all but one putative species occur there. All individuals outside of Ethiopia belong to a single recently diverged and expanded clade. This species should bear the name T. annectens (Thomas, 1891), and all other names of taxa described from outside of Ethiopia should be considered its junior synonyms. However, to solve taxonomic issues, future detailed morphological analyses should be conducted on all main clades together with genetic analysis of material from areas of their supposed contact. One of the most interesting findings of the study is the internal position of T. macrocephalus in T. splendens sensu lato. This demonstrates the intriguing phenomenon of accelerated morphological evolution of rodents occupying the Afroalpine zone in Ethiopia. Finally, we discuss how the distribution of Tachyoryctes is influenced by competition with another group of subterranean herbivores on the continent, the African mole-rats. We assume that both groups do not compete directly as previously expected, but specialisation to different subterranean niches is the main factor responsible for their spatial segregation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

A cross-sectional study was conducted from October 2014 to July 2015 to determine the prevalence and populations of E. coli as well as the prevalence and antimicrobial susceptibility of E. coli O157:H7 isolated from raw milk. Biochemical and serological tests methods were used to confirm E. coli and E. coli O157:H7 and isolates were subjected to antimicrobial susceptibility test using the agar disc diffusion method. Out of 380 raw milk samples examined, 129 (33.9%) and 11 (2.9%) were contaminated with E. coli and E. coli O157:H7, respectively. The highest prevalence was recorded in samples obtained from vendors (39.1%, 4.978 ± 0.180 log 10 /ml) compared with samples from farmers (28.1%, 3.93 ± 0.01 log 10 /ml) with significant differences ( P = 0.02). The frequency of contamination was higher in the samples collected from milk that was stored and transported in plastic containers (39.4%) than in the containers made of stainless steel (23.0%) ( P = 0.002). The antimicrobial susceptibility profile showed that E. coli O157:H7 were resistant to tetracycline (81.8%), streptomycin (81.8%), and kanamycin (63.6%). Milk samples were produced and handled under poor hygienic conditions, stored, and transported in inappropriate containers and under temperature abuse conditions leading to high health risk to the consumers. Additional studies would be needed to establish association between the occurrences of E. coli O157:H7 in raw milk and all the risk factors involved in and around Asosa town., Competing Interests: The authors declare that there is no conflict of interests.

Background: Efforts to address shortages of health workers in low-resource settings have focused on rapidly increasing the number of higher education programs for health workers. This study examines selected competencies achieved by graduating Bachelor of Science and nurse anesthetist students in Ethiopia, a country facing a critical shortage of anesthesia professionals., Methods: The study, conducted in June and July 2013, assessed skills and knowledge of 122 students graduating from anesthetist training programs at six public universities and colleges in Ethiopia; these students comprise 80% of graduates from these institutions in the 2013 academic year. Data was collected from direct observations of student performance, using an objective structured clinical examination approach, and from structured interviews regarding the adequacy of the learning environment., Results: Student performance varied, with mean percentage scores highest for spinal anesthesia (80%), neonatal resuscitation (74%), endotracheal intubation (73%), and laryngeal mask airway insertion check (71%). Average scores were lowest for routine anesthesia machine check (37%) and preoperative screening assessment (48%). Male graduates outscored female graduates (63.2% versus 56.9%, P = 0.014), and university graduates outscored regional health science college graduates (64.5% versus 55.5%, P = 0.023). Multivariate linear regression found that competence was associated with being male and attending a university training program. Less than 10% of the students believed that skills labs had adequate staff and resources, and only 57.4% had performed at least 200 endotracheal intubations at clinical practicum sites, as required by national standards., Discussion: Ethiopia has successfully expanded higher education for anesthetists, but a focus on quality of training and assessment of learners is required to ensure that graduates have mastered basic skills and are able to offer safe services.

A new strain of yellow-green algae (Xanthophyceae, Heterokonta), tentatively named Heterococcus sp. DN1 (UTEX accession number UTEX ZZ885), was discovered among snow fields in the Rocky Mountains. Axenic cultures of H. sp. DN1 were isolated and their cellular morphology, growth, and composition of lipids were characterized. H. sp. DN1 was found to grow at temperatures approaching freezing to accumulate large intracellular stores of lipids. H. sp. DN1 produces the highest quantity of lipids when grown undisturbed with high light in low temperatures. Of particular interest was the accumulation of eicosapentaenoic acid, known to be important for human nutrition, and palmitoleic acid, known to improve biodiesel feedstock properties., (© 2013 American Institute of Chemical Engineers.)