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Background: Tuberculosis remains a leading infectious cause of death in resource-limited settings. Effective treatment is the cornerstone of tuberculosis control, reducing mortality, recurrence and transmission. Supporting treatment adherence through facility-based observations of medication taking can be costly to providers and patients. Digital adherence technologies (DATs) may facilitate treatment monitoring and differentiated care. The ASCENT-Ethiopia study is a three-arm cluster randomised trial assessing two DATs with differentiated care for supporting tuberculosis treatment adherence in Ethiopia. This study is part of the ASCENT consortium, assessing DATs in South Africa, the Philippines, Ukraine, Tanzania and Ethiopia. The aim of this study is to determine the costs, cost-effectiveness and equity impact of implementing DATs in Ethiopia. Methods and design: A total of 78 health facilities have been randomised (1:1:1) into one of two intervention arms or a standard-of-care arm. Approximately 50 participants from each health facility will be enrolled on the trial. Participants in facilities randomised to the intervention arms are offered a DAT linked to the ASCENT adherence platform for daily adherence monitoring and differentiated response for those who have missed doses. Participants at standard-of-care facilities receive routine care. Treatment outcomes and resource utilisation will be measured for each participant. The primary effectiveness outcome is a composite index of unfavourable end-of-treatment outcomes (lost to follow-up, death or treatment failure) or treatment recurrence within 6 months of end-of-treatment. For the cost-effectiveness analysis, end-of-treatment outcomes will be used to estimate disability-adjusted life years (DALYs) averted. Provider and patient cost data will be collected from a subsample of 5 health facilities per study arm, 10 participants per facility (n = 150). We will conduct a societal cost-effectiveness analysis using Bayesian hierarchical models that account for the individual-level correlation between costs and outcomes as well as intra-cluster correlation. An equity impact analysis will be conducted to summarise equity efficiency trade-offs. Discussion: Trial enrolment is ongoing. This paper follows the published trial protocol and describes the protocol and analysis plan for the health economics work package of the ASCENT-Ethiopia trial. This analysis will generate economic evidence to inform the implementation of DATs in Ethiopia and globally. Trial registration: Pan African Clinical Trial Registry (PACTR) PACTR202008776694999. Registered on 11 August 2020, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12241. [ABSTRACT FROM AUTHOR]

Smallholder farmers require viable adaptation strategies for addressing climate change. Climate change adaptation project might be maladapted unless it considers the local context. This paper argued challenges of agriculture in developing countries in general and Ethiopia in particular, are highly diversified, and thus any intervention requires embarrassing the specific agroecosystems. Cognizant of this fact, the research investigated locally viable climate change adaptation strategies (CCAS) specific to Rib watershed in Ethiopia by using agroecosystem analysis framework. The study used primary data collected from 383 randomly selected farm-households complemented with data collected with key-informant interviews and focus group discussions. The study area was characterized and mapped in two groups of agroecosystems: Fogera plain and Libo-Farta highlands. The finding portrayed that across agroecosystems, there were considerable differences in terms of productivity potential, inherit constraints, crop varieties, income level and soil type. The study found the blanket application of similar CCAS irrespective of the heterogeneities. Farmers in the plain land witnessed less income inequality that stood at a Gini coefficient of 38.3 as compared to the highlanders of 42.8. The study further identified prioritized CCAS for the respective agroecosystems. It is imperative to consider local diversities before any intervention efforts. [ABSTRACT FROM AUTHOR]

The Ethiopian health system faces persistent inequities in health-care utilization and outcomes, despite continued efforts to expand health service coverage. There is little evidence in the literature describing the status of equity in the quality of healthcare. This paper aims to understand the disparities in quality of antenatal care (ANC) and family planning (FP) among the poor and non-poor communities. We used the 2016 Ethiopia Demographic and Health Survey (DHS) data to compute a Multidimensional Poverty Index (MPI), and the 2014 Service Provision Assessment (SPA) data to assess quality of ANC and FP services—defined as the level of adherence to World Health Organization (WHO) clinical and service guidelines. We merged the two datasets using geographical coordinates, and aggregated service users into facility catchment area clusters using a 2-km radius for urban and 10-km radius for rural facilities. We computed ANC and FP quality and MPI indices for each facility and assigned these to catchment areas. Using the international cutoff point for deprivation (MPI = 33.3%), we evaluated whether the quality of ANC and FP services varies by poor and non-poor catchment areas. We found that most of catchment areas (75.7%) were deprived. While the overall quality of ANC and FP services are low (33% and 34% respectively), we found little variation in the distribution of the quality of these services between poor and non-poor areas, urban and rural settings, or regionally. The short-term focus needs to be on improving the overall quality of services rather than on its distribution. [ABSTRACT FROM AUTHOR]

Since sport extends well beyond the routine of practice and competition and leads to the development of skills that affect other areas of life, my study explored whether girl athletes experience greater voice empowerment as a result of playing sport. The term voice empowerment is unique to traditional leadership and character programming; it emerged from recent scholarship in the fields of education, sport, and psychology. In this study, 30 Ethiopian girl athletes aged 13 to 18 completed a 24-item questionnaire that focused on the constructs of sport, voice, and gender equity. My findings suggest that sport along with emotional and academic support, coupled with an effective life skills program, does affect voice empowerment. [ABSTRACT FROM AUTHOR]

Learning is a fundamental human right, the basis of developing human capital and the foundation of human development. Basic skills provide individuals, their families and communities with the foundations needed to participate in society and to achieve better life chances. The shift in focus from mass access to mass learning has drawn attention to the question of who is and is not attaining these skills, and why. Opportunities to learn depend on access to schooling, but also the effectiveness of that schooling. There is considerable evidence of learning inequalities, both across and within countries. However, less is known about whether these patterns of inequality are rooted in variations in school effectiveness. In this paper we use evidence from Young Lives school surveys in Ethiopia, India and Vietnam to consider differences in girls' and boys' learning outcomes and progress and investigate how these patterns relate to school effectiveness. We explore whether girls or boys are 'sorted' into more or less effective schools and whether the same schools are differentially effective for boys and girls. Findings from India are perhaps closest to the 'typical' story that is often heard, in which girls, particularly those in rural areas, have lower attainment and attend less effective schools. In comparison, in Vietnam, girls have higher test scores and attend more effective schools on average, with this pattern driven by the higher performance of girls in rural areas. In Ethiopia, the divide between urban and rural areas is predominant in this context, over and above other areas of inequality including gender. Comparing results from these different areas of analysis and from three very different countries reveals the complexities of understanding how gender relates to educational outcomes. It demonstrates the importance of understanding gendered outcomes and school effectiveness in context. • Educational outcomes depend on access to education and the quality of that education. • Cross-country analysis reveals the complexities of how gender and school effectiveness relate to educational outcomes. • In India, where there is greatest school choice, girls have lower attainment and attend less effective schools than boys. • In Vietnam, the opposite is true - girls perform better and attend more effective schools. • In Ethiopia, the divide between urban and rural areas is predominant, over other axes of inequality including gender. [ABSTRACT FROM AUTHOR]

Annual, in-person professional meetings at a single location yield several personal and organizational benefits. Yet greenhouse gas emissions from organizing, executing, and attending conferences contribute significantly to the climate crisis. Within at least the last decade, the American Society of Landscape Architects (ASLA) has claimed to continually reduce the carbon footprint of the annual meeting and EXPO by performing a variety of actions. ASLA supports global and national greenhouse gas emissions reduction targets to limit global warming to 1.5°C and has committed to measuring, understanding, making public, and reducing the organization's emissions. To date, ASLA has not released information on its progress toward these goals. This study extends my previous work by estimating carbon dioxide emissions from the venues of the 2018 and 2019 ASLA Annual Meeting and EXPO and from travel and hotel accommodations for the attendees and 711 EXPO exhibitors. This study used online carbon calculators, refereed literature, and building energy benchmarking data. The results indicate that featured speakers and EXPO representatives originated from a small number of metropolitan areas, thereby supporting potential future decentralized meetings. Additionally, attendees' and exhibitors' total four-day conference emissions estimations were equivalent to the entire annual per capita emissions of someone residing in Ethiopia. In light of these results, I present ideas for several alternative means of convening. My emissions estimations of alternative conference modes indicate that emissions reduction targets could bemet in the short term by immediatelymoving to hybridizedmeetings requiring virtual attendance fromat least half of the participants from the most distant locations. In the long term, and by 2030 at the latest, ASLA's annual meetings should be held entirely online. [ABSTRACT FROM AUTHOR]