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World Health Organizations launched a global action plan on antimicrobial resistance since 2015. Along with other objectives, the plan was aimed to strengthen knowledge of the spread of antimicrobial resistance through surveillance and research. Given their high bacterial densities and that they receive antibiotics, metals, and other selective agents, wastewater systems are a logical hotspot for antibiotic resistance surveillance. The current study reports on the result of antibiotic resistance surveillance conducted in selected wastewater systems of Eastern Ethiopia from Feb. 2018 to Oct. 2019. We monitored three wastewater systems in Eastern Ethiopia, such as the activated sludge system of Dire Dawa University, waste stabilization pond of Haramaya University, and a septic tank of Hiwot Fana Specialized University Hospital for 18 months period. We collected 66 wastewater samples from 11 sampling locations and isolated 722 bacteria using selective culture media and biochemical tests. We tested their antibiotic susceptibility using the standard Kirby-Bauer disk diffusion method on the surface of the Mueller-Hinton agar and interpreted the result according to EUCAST guidelines. The result shows the highest percentage of resistance for ampicillin among isolates of hospital wastewater effluent which is 36 (94.7%), 33 (91.7%), and 32 (88.9%) for E. coli, E. faecalis, and E. faecium, respectively. A lower rate of resistance was seen for gentamicin among isolates of activated sludge wastewater treatment system which is 10 (16.4%), 8 (13.3%), 11 (18.9%), and 12 (20.3%) for E. coli, E. faecalis, E. faecium, and P. aeruginosa, respectively. Hospital wastewater exhibited higher resistance than the other two wastewater systems. The Multiple Antibiotic Resistance Index (MARI) has significantly increased in the wastewater’s course treatment process, showing the proliferation of resistance in the wastewater treatment system.

Introduction: Evidence shows that 10 to 20% of food-borne outbreaks perceptible in developing countries. The objective of this study was to assess the magnitude of hygienic practice of complementary food preparation and associated factors among mothers with children aged from 6 to 24 months in rural kebeles of Harari region, Ethiopia. The Method is a community based cross-sectional study design which was implemented on 422 of sampled mothers. Simple random sampling method was used to select those study participants. The data was collected using pre-tested and structured questionnaires. Data was processed, coded and entered into epi data version 3.02, exported to SPSS Version 20 and analyzed. Odds ratio along with 95% CI was estimated to measure the strength of the association. Finally, level of statistically significant was declared at P-value

Spatially distributed hydrologic models are useful for understanding the water balance dynamics of catchments under changing conditions, thereby providing important information for water resource management and decision making. However, in poorly gauged basins, the absence of reliable and overlapping in situ hydro-meteorological data makes the calibration and evaluation of such models quite challenging. Here, we explored the potential of using streamflow signatures extracted from historical (not current) streamflow data, along with current remote sensing-based evapotranspiration data, to constrain the parameters of a spatially distributed Soil and Water Assessment Tool (SWAT) model of the Mara River Basin (Kenya/Tanzania) that is forced by satellite-based rainfall. The result is a reduced bias of the simulated estimates of streamflow and evapotranspiration. In addition, the simulated water balance dynamics better reflect underlying governing factors such as soil type, land cover and climate at both annual and seasonal time scales, indicating the structural and behavioral consistency of the calibrated model. This study demonstrates that the judicious use of available information can help to facilitate meaningful calibration and evaluation of hydrologic models to support decision making in poorly gauged river basins around the world.

Objective: Reproductive rights violations are a serious public health concern worldwide, particularly in Sub-Saharan Africa, where more than 38.83% of victims live. Understanding the status of husbands’ knowledge and involvement helps to establish important programs and interventions. However, there are limited data related to husbands’ roles in women’s reproductive rights in the study setting. Therefore, this study aimed to assess husbands’ knowledge and involvement in women’s reproductive rights and their associated factors in Harar, eastern Ethiopia. Methods: A community-based cross-sectional study was conducted among 611 husbands in March 2020. A systematic random sampling technique was used to select the study participants. Data were collected using a structured and pretested interviewer-administered questionnaire. Data were entered using EpiData 3.1 and analyzed with SPSS Version 22. A multivariable logistic regression model was applied to examine the factors associated with the outcome variable using an adjusted odds ratio with a 95% confidence interval, and a p-value Results: The levels of husbands’ knowledge and involvement were 48.3% and 40.1%, respectively. Social media utilization (adjusted odds ratio = 4.97, 95% confidence interval = 2.79–8.85), partners’ discussion (adjusted odds ratio = 2.33, 95% confidence interval = 1.60–3.39), and type of facility: hospital (adjusted odds ratio = 3.21, 95% confidence interval = 1.23–8.36) and health post (adjusted odds ratio = 2.86, 95% confidence interval = 1.20–6.94) were factors associated with knowledge of husbands. Likewise, the experience of using reproductive services (adjusted odds ratio = 2.15, 95% confidence interval = 1.52–3.03), partner discussion (adjusted odds ratio = 1.95, 95% confidence interval = 1.35–2.82), social media utilization (adjusted odds ratio = 1.74, 95% confidence interval = 1.05–2.89), and age 40–49 years (adjusted odds ratio = 1.99, 95% confidence interval = 1.19–3.32) were factors associated with husbands’ involvement. Conclusion: Less than half of the husbands were knowledgeable and involved in executing partners’ reproductive rights. Promoting and creating effective media utilization is important for creating awareness of reproductive rights. Moreover, working on reproductive health service utilization, women empowerment, and making open discussions between partners are crucial to increase the knowledge and involvement of husbands.

Teketel Addise,1 Tadesse Alemayehu,2 Nega Assefa,2 Desta Erkalo3 1Anilemo District Health Office, Hadiya Zone, Southern Ethiopia; 2College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 3College of Medicine and Health Sciences, Wachemo University, Hosanna, EthiopiaCorrespondence: Desta ErkaloCollege of Medicine and Health Sciences, Wachemo University, Hosanna, EthiopiaEmail erkde12@gmail.comBackground: Community-based health insurance (CBHI) schemes are an emerging strategy for providing financial protection against healthcare-related poverty. In Ethiopia, CBHI is being piloted in 13 districts, but community experience and satisfaction with the scheme have yet to be studied.Objective: To assess the magnitude of satisfaction and associated factors among household heads who visited health facilities with community-based health insurance schemes in the Anilemo district Hadiya Zone Southern Ethiopia.Methods: A community-based cross-sectional study design was conducted for 627 household heads in the Anilemo district, from March 1– 30, 2020. Study participants were selected using stratified random sampling for kebeles and systematic sampling for study households. Data were collected by trained data collectors using a pre-tested structured questionnaire. Descriptive statistics, bivariate, and multivariate logistic regression analyses were performed. P values less than 0.05 with 95% confidence intervals were used to determine associations between independent and dependent variables.Results: The magnitude of household heads’ satisfaction was 54.1%. Household heads age [AOR=1.70;95% CI 1.09– 2.67], households income [AOR=0.19; 95% CI 0.11– 0.35], knowledge of CBHI benefit packages [AOR=3.15; 95% CI 1.97– 5.03], agreement with laboratory services [AOR=2.25; 95% CI 1.40– 3.62], and got and agreed with prescribed drugs [AOR=2.69; 95% CI 1.66– 4.37] were significantly associated with the magnitude of household heads satisfaction with community-based health insurance.Conclusion: About half of the household heads who visited health facilities with CBHIS were satisfied. Age, household’s income, knowledge of CBHI benefit packages, agreement with laboratory service provision, availability and agreement with prescribed drugs were significant predictors of satisfaction with CBHI. Therefore, much effort could be required to increase the magnitude of the household head’s satisfaction with the scheme.Keywords: community-based health insurance, satisfaction, household heads

Objective: Reproductive rights violations are a serious public health concern worldwide, particularly in Sub-Saharan Africa including Ethiopia, where more than 38.83% of victims are living. Understanding the status of husbands’ knowledge and involvement helps to set important programs and interventions. However, there is a paucity of data related to husbands' roles in women's reproductive rights in the study setting. Therefore, this study aimed to assess husbands’ knowledge and involvement in women's reproductive rights and associated factors in Harar, eastern Ethiopia. Methods: A community-based cross-sectional study was conducted on 611 husbands in March 2020. A multi-stage sampling and a systematic random sampling technique were used to select districts and study participants. Data were collected using an interviewer-administered questionnaire. Data were entered using EpiData 3.1 and analyzed with SPSS Version 22. Multivariable logistic regression was used to examine associated factors. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used, and a p-value Results: The magnitude of husbands' knowledge and involvement were 48.3% and 40.1% respectively. Social media utilization (AOR=4.97; 95% CI: 2.79-8.85), Spousal discussion (AOR=2.33; 95% CI: 1.60-3.39), nearby facility types: hospital (AOR=3.21; 95% CI: 1.23-8.36) and health post (AOR=2.86; 95% CI: 1.20-6.94) were associated factors with knowledge of husbands. Likewise, experience of using reproductive health services (AOR=2.15; 95% CI: 1.52-3.03), spousal discussion (AOR=1.95; 95% CI: 1.35-2.82), social media use (AOR=1.74; 95% CI: 1.05-2.89) and age 40 to 49 years (AOR=1.99, 95%CI: 1.19-3.32) were associated with husbands involvement.Conclusions: Less than half of the husbands were knowledgeable and involved in the protection of partners’ reproductive rights. Promoting and creating effective media utilization is very important to create awareness of reproductive rights. Moreover, using reproductive health services and empowering women to have an open discussion is crucial to increase the knowledge and involvement of husbands.

Healthcare waste management (HWM) problems are growing with an ever-increasing number of hospitals, clinics, diagnostic laboratories, etc in Ethiopia. Health workers are one of the key personnel who are responsible for the proper management of healthcare wastes at any health facilities. However, this performance will depend the level of knowledge and practice regarding waste management. A facility based cross-sectional study design was applied on 400 health workers. All public health institutions inside Jigjiga town were included and the study participants were randomly selected from each health facility. Data were collected using pre-tested and self administered questionnaire. The collected data was analyzed using SPSS version 20. Multivariable logistic regression model was used to identify factors associated with knowledge and practice of health workers. Out of those involved in this study, 47.7% and 42.3% of respondents had good knowledge and good practice on healthcare waste management, respectively. Health workers in the age group of 35-44 years, nurses, midwifes, medical laboratory, were significantly associated with knowledge of health workers. On the other hand, only educational status was significantly associated with practice. In this study, both knowledge and practice of health workers about healthcare waste management was poor. To enhance both the knowledge and practice of health workers, on job training is recommended.

Accurate and spatially distributed rainfall data are crucial for a realistic simulation of the hydrological processes in a watershed. However, limited availability of observed hydro-meteorological data often challenges the rainfall–runoff modelling efforts. The main goal of this study is to evaluate the Climate Forecast System Reanalysis (CFSR) and Water and Global Change (WATCH) rainfall by comparing them with gauge observations for different rainfall regimes in the Mara Basin (Kenya/Tanzania). Additionally, the skill of these rainfall datasets to simulate the observed streamflow is assessed using the Soil and Water Assessment Tool (SWAT). The daily CFSR and WATCH rainfall show a poor performance (up to 52% bias and less than 0.3 correlation) when compared with gauge rainfall at grid and basin scale, regardless of the rainfall regime. However, the correlations for both CFSR and WATCH substantially improve at monthly scale. The 95% prediction uncertainty (95PPU) of the simulated daily streamflow, as forced by CFSR and WATCH rainfall, bracketed more than 60% of the observed streamflows. We however note high uncertainty for the high flow regime. Yet, the monthly and annual aggregated CFSR and WATCH rainfall can be a useful surrogate for gauge rainfall data for hydrologic application in the study area.

The Soil and Water Assessment Tool (SWAT) is a globally applied river basin ecohydrological model used in a wide spectrum of studies, ranging from land use change and climate change impacts studies to research for the development of the best water management practices. However, SWAT has limitations in simulating the seasonal growth cycles for trees and perennial vegetation in the tropics, where rainfall rather than temperature is the dominant plant growth controlling factor. Our goal is to improve the vegetation growth module of SWAT for simulating the vegetation variables – such as the leaf area index (LAI) – for tropical ecosystems. Therefore, we present a modified SWAT version for the tropics (SWAT-T) that uses a straightforward but robust soil moisture index (SMI) – a quotient of rainfall (P) and reference evapotranspiration (ETr) – to dynamically initiate a new growth cycle within a predefined period. Our results for the Mara Basin (Kenya/Tanzania) show that the SWAT-T-simulated LAI corresponds well with the Moderate Resolution Imaging Spectroradiometer (MODIS) LAI for evergreen forest, savanna grassland and shrubland. This indicates that the SMI is reliable for triggering a new annual growth cycle. The water balance components (evapotranspiration and streamflow) simulated by the SWAT-T exhibit a good agreement with remote-sensing-based evapotranspiration (ET-RS) and observed streamflow. The SWAT-T model, with the proposed vegetation growth module for tropical ecosystems, can be a robust tool for simulating the vegetation growth dynamics in hydrologic models in tropical regions.

Background : Antimicrobial resistance is one of the major public health challenges in the 21st century. In response, World Health Organizations launched a global action plan on antimicrobial resistance since 2015, which is, along with other objectives, aimed to strengthen knowledge of the spread of Antimicrobial resistance through surveillance and research. As wastewater systems are important reservoirs of communal human and animal bacteria, antibiotic residue and resistance genes they are considered as surveillance hotspots. Objective : To assess the antibiotic resistance profile of proposed environmental resistance indicator bacteria in selected wastewater systems of Eastern Ethiopia from Feb. 2018 to Oct. 2019. Method : Three wastewater management systems in Eastern Ethiopia, such as the activated sludge system of Dire Dawa University, waste stabilization pond of Haramaya University and a septic tank of Hiwot Fana Specialized University Hospital were monitored by sampled quarterly over 18 months. A total of 66 samples was collected from 11 sampling locations and a total of 722 Escherichia coli (151), Aeromonas spp. (142), P. aeruginosa (143), E. faecalis (144), and E. faecium (142) were isolated using selective culture media and biochemical tests. Their antimicrobial susceptibility was tested using standard Kirby-Bauer disk diffusion method on the surface of the Mueller-Hinton agar and the result was interpreted according to EUCAST guidelines. Multiple Antibiotic Resistance Index (MARI) was calculated for each isolate and its change in the course of treatment was evaluated. Result : The highest percentage of resistance was seen for ampicillin among isolates of hospital wastewater effluent which is 36(94.7%), 33(91.7%) and 32(88.9%) for E. coli, E. faecalis, and E. faecium respectively. Lower rate of resistance was seen isolates from activated sludge system and gentamicin for isolates of activated sludge wastewater treatment system which is 10(16.4%), 8(13.3%), 11(18.9%), and 12(20.3%) for E. coli, E. faecalis, E. faecium , and P. aeruginosa respectively. MERI value was found to be variable across monitored sites and the course of the wastewater treatment process. Conclusion : The study has found a high level of environmental antibiotic resistance indicator bacteria thrive in the wastewater systems most of which were multi-resistant. Hospital wastewater exhibits higher resistance than the other two wastewater systems. The multi-drug resistance index has significantly increased in the course of the wastewater treatment process, indicating the possible proliferation of resistance in the wastewater treatment system.

Background. Goiter is an abnormal enlargement of the thyroid gland due to inadequate intake of iodine and goitrogenic food. It is the most important public health problem in developing countries like Ethiopia and specifically in East Gojjam. Though there are studies on goiter in Ethiopia, the magnitude is not well known and documented in Debre Markos town on pregnant women. Therefore, this study was carried out to assess the magnitude of visible goiter and associated factors among pregnant women visiting antenatal clinic in three public health facilities of Debre Markos town, North West Ethiopia. Methods. Facility-based cross-sectional study was conducted on 401 pregnant women visiting antenatal clinics at three public health facilities using the systematic sampling technique. Data were collected using pretested structured questionnaire by an interview method. All pregnant women were examined for the presence of goiter using World Health Organization (WHO) criteria. Both bivariate and multivariable binary logistic regression analyses were used to see the association between dependent and each independent variable. Result. The prevalence of visible goiter was found to be 10.5% (95% CI: 7.5–13.5). Visible goiter was more common in the age category between 15 and 19 years. Low household income (AOR = 4.5, 95% CI: 1.1–18.7), cabbage intake (AOR = 5.2, 95% CI: 1.2–22.3), and poor knowledge about the benefits of iodized salt (AOR = 2.4, 95% CI: 1.1, 5.2) were factors associated with visible goiter. Conclusion and Recommendation. Visible goiter is a major public health problem in this study area. Low socioeconomic status, low knowledge of pregnant women about the merits of iodized salt, and frequent intake of goitrogenic foods such as cabbage increase the risk of developing visible goiter. Therefore, due emphasis on goiter prevention and control strategies, increasing knowledge of women on the benefit of iodized salt, including low-income households in safety net programs, and nutritional education on iodine-rich diets (such as tuna, dairy products, and egg) should be emphasized to alleviate the problem.

Background Short birth interval is a universal public health problem resulting in adverse fetal, neonatal, child and maternal outcomes. In Ethiopia, more than 50% of the overall inter birth spacing is short. However, prior scientific evidence on its determinants is limited and even then findings are inconsistent. Methods A community -based unmatched case-control study was employed on 218 cases and 436 controls. Cases were ever married reproductive age women whose last delivery has been in the past five years with birth interval of less than 3 years between the latest two successive live births whereas those women with birth interval of 3–5 years were taken as controls. A multistage sampling technique was employed on 30% of the kebeles in Dessie city administration. A pre-tested interviewer based questionnaire was used to collect data by 16 trained diploma nurses and 8 health extension workers supervised by 4 BSc nurses. The collected data were cleaned, coded and double entered into Epi-data version 4.2 and exported to SPSS version 22. Binary logistic regression model was considered and those variables with P Result In this study, contraceptive use (AOR = 11.2, 95% CI: 5.95–21.15), optimal breast feeding for at least 2 years (AOR = 0.098, 95% CI:0.047–0.208), age at first birth Conclusion Contraceptive use, duration of breast feeding, age at first birth, preceding child sex and correct understanding of the duration of birth interval were significant determinants of short birth interval. Fortunately, all these significant factors are likely modifiable. Thus, the existing efforts of optimizing birth interval should be enhanced through proper designation and implementation of different strategies on safe breastfeeding practice, modern contraceptive use and maternal awareness about the health merits of optimum birth interval.

Additional file 1: Table S1. Distribution of socio-demographic characteristics of pregnant womenâ s attending ANC in North Wollo Zone, northern Ethiopia, 2018.

The Soil and Water Assessment Tool (SWAT) is a globally applied river basin eco-hydrological simulator in a wide spectrum of studies, ranging from land use change and climate change impacts studies to research for the development of best water management practices. However, SWAT has limitations in simulating the seasonal growth cycles for trees and perennial vegetation in tropics, where the major plant growth controlling factor is the rainfall (via soil moisture) rather than temperature. Our goal is to improve the vegetation growth module of the SWAT model for simulating the vegetation parameters such as the leaf area index (LAI) for tropics. Therefore, we present a modified SWAT version for the tropics (SWAT-T) that uses of a simple but robust soil moisture index (SMI) – a quotient of the rainfall (P) and reference evapotranspiration (PET) – to initiate a new growing season after a defined dry season. Our results for the Mara Basin (Kenya/Tanzania) show that the SWAT-T simulated LAI corresponds well with the Moderate Resolution Imaging Spectroradiometer (MODIS) LAI for evergreen forest, savanna grassland and shrubs, indicating that the SMI is a reliable proxy to dynamically initiate a new growing cycle. The water balance components (evapotranspiration and flow) simulated by the SWAT-T exhibit a good agreement with remote sensing-based evapotranspiration (RS-ET) and observed flow. The SWAT-T simulator with the proposed improved vegetation growth module for tropical ecosystem could be a robust tool for several applications including land use and climate change impact studies.

Ideally, the results from models operating at different scales should agree in trend direction and magnitude of impacts under climate change. However, this implies that the sensitivity to climate variability and climate change is comparable for impact models designed for either scale. In this study, we compare hydrological changes simulated by 9 global and 9 regional hydrological models (HM) for 11 large river basins in all continents under reference and scenario conditions. The foci are on model validation runs, sensitivity of annual discharge to climate variability in the reference period, and sensitivity of the long-term average monthly seasonal dynamics to climate change. One major result is that the global models, mostly not calibrated against observations, often show a considerable bias in mean monthly discharge, whereas regional models show a better reproduction of reference conditions. However, the sensitivity of the two HM ensembles to climate variability is in general similar. The simulated climate change impacts in terms of long-term average monthly dynamics evaluated for HM ensemble medians and spreads show that the medians are to a certain extent comparable in some cases, but have distinct differences in other cases, and the spreads related to global models are mostly notably larger. Summarizing, this implies that global HMs are useful tools when looking at large-scale impacts of climate change and variability. Whenever impacts for a specific river basin or region are of interest, e.g. for complex water management applications, the regional-scale models calibrated and validated against observed discharge should be used.

The water resources of the Lake Tana catchment are largely untapped. Currently, water resource development is being promoted to stimulate economic growth. This study utilized the WEAP model to determine the likely impact of a number of possible development scenarios on lake water levels. For each scenario, the model was used to simulate water demand in three sectors (i.e. irrigation, hydropower and downstream environmental flows) over a 36-year period of varying flow and rainfall. The simulation results revealed that if all the planned development occurs on average 2198 GWhy −1 power could be generated and 677 Mm 3 y −1 of water supplied to irrigation schemes. However, the mean annual water level of the lake would be lowered by 0.44 meters. As well as adverse ecological impacts this would have significant implications for shipping and the livelihoods of local people.

One of the key inputs of a hydrological model is the potential evapotranspiration (PET), which sets an upper limit to evapotranspirative water demand. However, limited data availability often challenges the choice of a PET estimation method, which in turn affects the PET estimates as well as the water balance (WB) components. The objectives of this research are (1) to evaluate the use of different sources of weather input data to derive PET: Climate Forecast System Reanalysis (CFSR) data, Water and Global Change (WATCH) data, and data generated by the weather generator of the soil and water assessment tool (SWAT) (SWAT–WG); and (2) to investigate the effects of the Penman–Monteith and Hargreaves (HG) methods on WB components using a SWAT-based model for the Upper Mara Catchment (Kenya). It is shown that PET estimations using the CFSR, WATCH, and SWAT–WG data sets compare well with the average annual and seasonal PET estimates from local observations over a period of 20 years. This shows the potential of global reanalysis climate data sources for the computation of PET in data-limited catchments. The SWAT models forced by these data sets and by gauged rainfall show a modified Nash–Sutcliffe (NSm) efficiency ranging from 0.6 to 0.72 for the simulation of the flow, depending on the selected PET estimation method. Unlike water yield, the other WB components simulated by the SWAT models (ET, deep aquifer loss, and reevaporation from the shallow aquifer) vary in magnitude, depending on the data and methods being used. The sensitivity analysis and the calibration results show that the model parameters are sensitive to the choice of the PET estimation method. Therefore, for catchments where parameterization is a challenge owing to data scarcity, it is crucial to consider the appropriate PET estimation method for a realistic modeling of the hydrological processes. In our case study, the HG method gives more robust and realistic ET estimations.

Background “Contraceptive switching” from one method to another is a common phenomenon. Switching from a more effective long-acting method to a less effective method exposes women for unplanned pregnancy. The aim of this study was to assess the level and factors associated with long-acting family planning method switching to other methods. Method A facility-based cross-sectional study was conducted from January to March 2013 on 634 women attending public health facilities in Dire Dawa City Administration, Ethiopia. Participants of the study were revisit clients of family planning service and were interviewed as they appear in the clinics. Data were analyzed using crude and adjusted logistic regression, and results were reported using OR and corresponding 95 % CI. Results Long-acting family planning method switching among revisit clients was 40.4 %; switching from implant was 29.8 % and from IUCD, it was 10.6 %. The main reasons for methods switching were side effects of the methods such as bleeding, weight loss, and feeling of arm numbness. The tendency of switching was less among married women (AOR = 2.41, 95 % CI: 1.01, 5.74), women who had 2–4 and 5 and more children (AOR 3.00, 95 % CI: 1.59, 5.67) and (AOR 2.07, 95 % CI: 1.17, 3.66), respectively. It was also less among women who want to stop birth (AOR 5.11, 95 % CI: 1.15, 24.8), among those who mentioned health care providers as source of information for family planning (AOR 1.88, 95 % CI: 1.18, 3.01), and among women whose husbands were aware of their use of the methods (AOR 3.05, 95 % CI: 1.88, 4.94). Conclusions Method switching from long-acting contraceptives to less effective methods is high. Method switching was significant among unmarried women, who had one child, plan to postpone fertility, and whose husbands were not aware of their wive’s use of the method. In the provision of family planning service, the health care providers should give adequate information about each method and risks of method switching. Appropriate family planning Information Education and Communication (IEC) and Behavioral Change Communication (BCC) strategies should be emphasized.

Background: Globally, more than 2 billion people have been infected with Hepatitis B Virus (HBV) at some time in their lives. Of these, about 350 million people remain infected chronically and become carriers of the virus. The main aim of this study was to assess the prevalence of HBV infection and associated factors among blood donors at Dire Dawa Blood Bank Service in Eastern Ethiopia. Methods and materials: This study involves cross-sectional retrospective record review on 4,157 blood donors. During analyzing the data, descriptive analyses was made to determine the prevalence of hepatitis B virus in the study population. Finally, multivariable logistic regression model was used to identify factors associated with hepatitis B virus infection. Result: Out of the 4,157 individuals who donated their blood at Dire Dawa Blood Bank Services, 155 (3.73%) (95% Confidence Interval (CI)=3.15-4.31) confirmed having a sero-prevalence positive for HBV. HBV seroprevalence has shown a statistical significance association with male sex (Adjusted Odds Ratio (AOR)=1.93, 95% CI=1.10-3.55) (p=0.036) and age group 33-40 (AOR=3.7, 95% CI=1.19-9.56) (p=0.029). Conclusion: The prevalence of HBV infection in this study is high and the disease is still a major health problem in the region which calls for high alert public health intervention.

Background: Health facilities generate different types of wastes which are characterized as hazardous, most of which are toxic, harmful, carcinogenic and infectious. Waaste collectors face massive exposure to hazardous wastes and occupational accidents as a result of manual handling of healthcare waste and working under unfavourable conditions. Methodology: The study employed a cross-sectional study design on 253 medical wastes collectors interviewed using questionnaire from 65 health facilities. With an observational checklist, the healthcare waste management system of these health facilities was also assessed. For data analysis, factors associated with exposure to sharp injuries and blood and body fluids were identified by a binary logistic regression with Generalized Estimating Equation model to control the effect of clustering. Result: For the last one year, there were 75 (30%) waste collector who were exposed to any sharp material and 121 (43.8%) had exposure to blood and body fluid while handling healthcare wastes. Factors such as not wearing glove (AOR=3.5, CI=1.17-4.92, p=0.003), being uneducated AOR=1.55, CI=1.18-2.65, p=0.03) and not taking training (AOR=1.39, CI=1.27-2.48, p=0.01) were found to be associated with exposure to sharp injury and blood and body fluids. Conclusion: Medical waste collectors are exposed to high sharp injury and blood and body fluid. Adequate training before employment and on job, provision of personal protective devices and routine exposure reporting mechanism, testing, medication and post exposure prophylaxis and establishment of therapeutic centers are recommended

BackgroundUnplanned pregnancy from casual sex, unplanned sexual activity, and sexual violence are increasing. Emergency Contraceptives (EC) are used to prevent unplanned pregnancies thereby preventing the occurrence and consequences of unplanned pregnancy. Emergency contraception is widely available in Ethiopia particularly in major cities. Yet the use of EC is very low and abortion rate in cities is high compared to the national average.ObjectivesTo assess knowledge, attitude and practice and determinants on the use of emergency contraception among women obtaining abortion service at selected health institutions in Dire Dawa, Eastern Ethiopia.MethodsA facility based cross-sectional study was conducted on 390 women selected by multi-stage random sampling technique. The samples were generated from government and private for non profit health facilities. Participant's knowledge and attitude towards emergency contraception were measured using composite index based on 7 and 9 questions, respectively and analyzed using mean score to classify them as knowledgeable or not, and have positive attitude or not. Practice was assessed if the women reported ever use of emergency contraception. Determinants of use of emergency contraception were analyzed using logistic regression.ResultOut of 390 women interviewed, 162 women (41.5%) heard about EC, only 133 (34.1%) had good knowledge, and 200 (51.3%) of the respondents had positive attitudes towards to EC. Ever use of EC was reported by 38 (9.7%). Age, living arrangement, education, marital status, religion were found to be significantly associated with the use of emergency contraceptives. Women with poor knowledge were less likely to use EC compared to the knowledgeable ones [AOR = 0.027, 95% CI (0.007, 0.105)].ConclusionThe study identified that most respondents lack adequate knowledge on the method of EC. In addition ever use of EC is very low.RecommendationsHealth professions should give attention in increasing knowledge and uptake of Emergency Contraception.

Background: Acute malnutrition refers to someone who has lost a significant amount of weight over a short period of time, resulting in being underweight or wasting. In refugee situations where the population is often extremely dependent on the humanitarian assistance and food aid, the value of the food will greatly determine their nutritional status. Objective: The main objective of this study was to assess the prevalence of acute malnutrition and its associated factors, among children aged 6-59 months in Mai-Aini Eritrean refugees’ camp, Northern Ethiopian in 2014. Methods: Community based cross-sectional study was conducted on 593 mother-child pairs between January 1 and 30, 2014. Anthropometric measurements of height and weight of children were taken and questionnaire prepared in local language (Tigrigna) were used to collect the data. Data were entered using EPI-data software (version 3.2) and exported to SPSS (version 16.0) for analysis. ENA for SMART 2007 software was used to convert nutritional data into Z-scores of the indices; weight-for-height and weight-for age. Bivariate and multivariate analyses were used to identify factors associated with child malnutrition. Results: The finding of this study revealed that 33.4% and 24.6% of children were underweight and wasted, respectively. Prevalence of acute malnutrition was higher in males compared to females. Underweight was associated with child age, consuming extra food during pregnancy and maternal BMI less than 18.5 Kg/m2. Children age and receiving pre-lactate food was independently associated with wasting. Conclusion: The prevalence of malnutrition among children aged 6-59 months was high, indicating that the nutrition situation in study area is very critical issue. Therefore, especial attention should be given on intervention of malnutrition.

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Background: Cigarette smoking is a known risk factor for chronic diseases. It is predicted that by the 2020s there will be about 10 million tobacco related deaths annually worldwide. Improved understanding of factors that contribute to smoking initiation and cessation may help to set strategies that lead to smoking behaviour change. Objective: To assess the prevalence of smoking, and factors associated with smoking initiation among military personnel. Method: A cross-sectional study was conducted and data was obtained from 398 men and women aged 18-52 years in two Defence military academies, located in Holeta and Awash Arba, 30 km and 250 km away from Addis Ababa, respectively. Information on smoking habits, socio-demographic and psycho-social factors were collected through self-administered questionnaire, from January to February 2011. The study population was selected by systematic sampling technique after stratification was made. Data was entered using Epi Info 3.51 version and analyzed using SPSS version 15. Bivariate analysis was used to examine association between dependent and independent variables. Result: Of 398 respondents 86 (21.6%) were current regular smokers, and 165(41.5%) reported having alcohol drinking habit. Majority of smokers were men, unmarried, low education and income status. Smoking initiation was associated with low educational status, OR (2.70, 95% CI, 1.14-6.39), and low income status, OR (3.29, 95% CI, 1.39-7.84). Conclusion: Current smoking status was found to be associated with low educational and low income status. Recommendation: Addressing socioeconomic and educational differences, by upgrading income status and promoting access to education and awareness raising on smoking harm will be required to reduce prevalence of smoking among military personnel.

This study was undertaken to assess the extent of pollution of water and contamination of vegetables grown by irrigation with polluted river water. The study was done in the Akaki and Mekanisa areas of Addis Ababa, Ethiopia in 2002. The need to investigate the extent of contamination of vegetables is valid because of repeated occurrence of food-born disease outbreaks in many restaurants in the city of Addis Ababa. This might be partly attributed to the consumption of such contaminated raw fruits and vegetables. The main aim of this study is to determine the microbiological qualities of irrigation water and vegetables, and to assess farmers perception and knowledge about contamination of food and water. Samples of water were collected from different parts of the river in research areas to detect some indicator and pathogenic microorganisms, mainly pathogenic bacteria most prevalent in the area. Different green leafy vegetables were also collected from farm areas and market places for bacteriological laboratory examinations. Both water and food samples were analyzed by standard conventional methods using different bacteriological growing media. Enteropathogens such as Salmonella and Shigella organisms were detected in 22 (73.33%) and 17 56.67%) of the water samples respectively. But, vegetables were positive for Salmonella in 33 (53.2%) and Shigella 24 (38.7%). The general awareness of farmers about water and food contamination is low, and this may lead to poor handling and processing of produces in different levels from production to consumption. Immediate action is needed to control water pollution that attributed to vegetable contamination during irrigation. The outcome of this study is expected to raise the awareness of the responsible bodies concerning pollution of river water and the potential risk of irrigation of fruits and vegetables with such water.

Background: Indiscriminate waste disposal by many healthcare facilities pose serious health hazard to the inhabitants in general and people living around health care facilities in particular. Human scavengers collecting second hand objects for reselling could be a channel for speading disease causing organisms. In addition, burning of wastes in small size incinerator at a low temperature releases many toxic gases causing health effects for people living around the facilities. The objective of the study was to assess risk perception of people living around health facilities about healthcare wastes. Methodology: A cross sectional study was conducted on 438 people in the eastern part of Ethiopia, from August to November 2013. Samples were taken by proportionate allocation to the size of people living within one km radius of 25 health facilities. Questionnaire was administered by a face-to-face interview. Risk perception was classified using a three-point Likert scale from low to high risk. Data were analyzed using STATA software. Bivariate and multi-variable analyses were carried out to determine correlates of risk perception. Result: The magnitude of risk perception for sharp, infectious/pathological wastes and expired drugs was 87%, 93.6%, and 73.1%, respectively. Individuals from urban areas have about 3 times higher odds of increased perceived risk than from rural areas (AOR = 3.02, 95% CI: 1.08-4.32, P = 0.006). On the other hand, people living around the hospitals have 2.5 times higher odds of increased perceived risk than those people living near to health centers (AOR = 2.45, 95% CI : 0.19 - 3.04, P = 0.000). Conclusion and recommendation: People involved in this study have high perceived risk for hazardous (infectious and sharp) wastes which might be due to indiscriminate discharges of wastes by the nearby health facilities. It is therefore advisable to dispose wastes in a proper manner in order to minimize public concern.